Provider Demographics
NPI:1912972373
Name:SANFORD, NICOLE LORRAINE (ATC, CSCS)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LORRAINE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:ATC, CSCS
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:158 HIGHLAND RD
Mailing Address - Street 2:APT 33
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-4211
Mailing Address - Country:US
Mailing Address - Phone:315-769-2808
Mailing Address - Fax:
Practice Address - Street 1:2345 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2211
Practice Address - Country:US
Practice Address - Phone:315-764-4917
Practice Address - Fax:315-764-4404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer