Individual
SANDY N BACALLAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12200 WARWICK BLVD, SUITE 310, NEWPORT NEWS, VA 23601-2344
(757) 534-9988
Mailing address
856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024174421
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154860484
—
VA
Enumeration date
02/20/2017
Last updated
05/15/2017
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