Provider Demographics
NPI:1588451272
Name:GAUTHIER, SANDRA
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WHITBY AVE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3327
Mailing Address - Country:US
Mailing Address - Phone:267-333-3175
Mailing Address - Fax:
Practice Address - Street 1:705 WHITBY AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3327
Practice Address - Country:US
Practice Address - Phone:267-333-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAG03250053363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology