Provider Demographics
NPI:1689664088
Name:SANDELLA, JEANNE M (DO)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:SANDELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E. OLNEY AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT, SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-254-0403
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1 IRON BRIDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2058
Practice Address - Country:US
Practice Address - Phone:484-622-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010761L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH23831OtherELDER CARE
PA2297175OtherUNITED HEALTHCARE
PA1423217OtherBLUE SHIELD
PA2108952000OtherKEYSTONE
PA3551485OtherAETNA
PA9253000OtherCIGNA
PAP00369951OtherPALMETTO GBA
PA9253000OtherCIGNA
PA041950Medicare PIN