Provider Demographics
NPI:1891721312
Name:PENSIERI, SANDRA LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:PENSIERI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1191
Mailing Address - Country:US
Mailing Address - Phone:570-829-4711
Mailing Address - Fax:570-283-1707
Practice Address - Street 1:1155 E MOUTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-7906
Practice Address - Country:US
Practice Address - Phone:570-808-3362
Practice Address - Fax:570-808-5114
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002479-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0956631Medicaid
PA0956631Medicaid
PAT28330Medicare UPIN