Provider Demographics
NPI:1851148118
Name:SANFORD, GARTH P
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:P
Last Name:SANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 MOOSE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-5324
Mailing Address - Country:US
Mailing Address - Phone:315-525-0657
Mailing Address - Fax:
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1297
Practice Address - Country:US
Practice Address - Phone:315-376-5200
Practice Address - Fax:315-376-9317
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY512055.01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse