Individual
SANDRA DEFALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4724 CHARLOTTE HWY, CLOVER, SC 29710-8095
(866) 389-2727
Mailing address
2420 IVY CREEK FRD, YORK, SC 29745-8146
(631) 741-9504
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20227
SC
363LF0000X
Family Nurse Practitioner
5008816
NC
363LF0000X
Family Nurse Practitioner
DEFA-B904U1
NC
Other
Enumeration date
08/05/2016
Last updated
08/09/2023
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