Provider Demographics
NPI:1023286911
Name:SIVILLI, SANDRA ANNA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNA
Last Name:SIVILLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRANGE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3401
Mailing Address - Country:US
Mailing Address - Phone:516-483-9012
Mailing Address - Fax:
Practice Address - Street 1:403 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5216
Practice Address - Country:US
Practice Address - Phone:516-378-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist