MEDICARE: KUSMATIE S SAKHAI RN

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	163W00000X	Registered Nurse	6393371	NY

General Provider Information

NPI Number	:	1497090815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUSMATIE S SAKHAI RN

Provider Business Mailing Address
First Line	:	15648 78TH ST
Second Line	:	APT#3
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-2514
Country	:	US
Telephone Number	:	917-288-1631
Fax Number	:

Provider Business Practice Location Address
First Line	:	15648 78TH ST
Second Line	:	APT#3
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-2514
Country	:	US
Telephone Number	:	917-288-1631
Fax Number	:

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

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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