MEDICARE: CHRISTINE SACHAKOV MHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401253	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401253-1	NY

General Provider Information

NPI Number	:	1386941573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE SACHAKOV MHNP

Provider Business Mailing Address
First Line	:	17 BUCKLEY ST UNIT 2
Second Line	:
City	:	LIBERTY
State	:	NY
Zip	:	12754-1704
Country	:	US
Telephone Number	:	845-747-5600
Fax Number	:	845-747-5700

Provider Business Practice Location Address
First Line	:	17 BUCKLEY ST UNIT 2
Second Line	:
City	:	LIBERTY
State	:	NY
Zip	:	12754-1704
Country	:	US
Telephone Number	:	845-747-5600
Fax Number	:	845-747-5700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	09/06/2023

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