Basic Information
Provider Information
NPI: 1669421764
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANDERS
FirstName: RHONDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 295 E SWEDESFORD RD
Address2: SUITE 129
City: WAYNE
State: PA
PostalCode: 190871462
CountryCode: US
TelephoneNumber: 3185739384
FaxNumber:  
Practice Location
Address1: 101 E OLNEY AVE
Address2: SUITE 400
City: PHILADELPHIA
State: PA
PostalCode: 191202421
CountryCode: US
TelephoneNumber: 2154567000
FaxNumber: 2152542599
Other Information
ProviderEnumerationDate: 05/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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