Provider Demographics
NPI:1992525802
Name:BUCKLAND, SANDRA JOLLOFF (BSN, PMH-RN, CARN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOLLOFF
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:BSN, PMH-RN, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3146
Mailing Address - Country:US
Mailing Address - Phone:540-290-6607
Mailing Address - Fax:
Practice Address - Street 1:85 SANGERS LN
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-6712
Practice Address - Country:US
Practice Address - Phone:540-213-7517
Practice Address - Fax:540-887-3238
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001238144163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health