Provider Demographics
NPI:1588371116
Name:SANDOR, ROXANA M
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:M
Last Name:SANDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 N FLAMINGO CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-2037
Mailing Address - Country:US
Mailing Address - Phone:208-860-4440
Mailing Address - Fax:
Practice Address - Street 1:1323 N FLAMINGO CT
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-2037
Practice Address - Country:US
Practice Address - Phone:208-860-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging