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Individual
SANDRA CUSTODIO
Active
Individual
SANDRA CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-PCNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2328892
MA
207RI0200X
Infectious Disease Physician
0024189672
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
0024189672
VA
363LA2200X
Adult Health Nurse Practitioner
RN2328892
MA
Other
Enumeration date
06/20/2014
Last updated
01/24/2025
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