Sandra Jean Vandyke, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024164146 Issued in VA

Practice address

18765 Riverside Dr
Vansant, VA 24656

Phone

(276) 935-2880

Fax

(276) 935-2889

NPI assigned

Nov 17, 2006

Last updated

Mar 30, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Sandra Jean Shortridge Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinch Valley Physicians Inc

  dba The Clinic

  • Multi-Specialty Clinic/Center
  • Richlands, VA
  • NPI 1912980855
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1669545398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 OLD VANDYKE HOLLOW RD",
            "city": "OAKWOOD",
            "state": "VA",
            "postal_code": "246318490",
            "telephone_number": "276-498-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18765 RIVERSIDE DR",
            "city": "VANSANT",
            "state": "VA",
            "postal_code": "24656",
            "telephone_number": "276-935-2880",
            "fax_number": "276-935-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDYKE",
        "first_name": "SANDRA",
        "middle_name": "JEAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024164146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "SHORTRIDGE",
            "middle_name": "JEAN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jane Adele Seymour, COTA/L
• Barbara L Shinall, FNP
• St. Charles Health Council Inc (Thompson Family Health Center)
• Vandyke Chiropractic PC
• Bradley Dean Vandyke, D.C.
• Viers Hunt Broyles, & Brown, Inc. (Family Drug)
• Anita Renee Woolford, MSN, NP-C

• Family Nurse Practitioner in Vansant, VA
• Providers in Vansant, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.