MEDICARE: CONNECTIONS - PSYCHIATRIC NP SERVICES, PLLC

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

General Provider Information

NPI Number	:	1902473465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTIONS - PSYCHIATRIC NP SERVICES, PLLC

Provider Business Mailing Address
First Line	:	17 BUCKLEY ST
Second Line	:
City	:	LIBERTY
State	:	NY
Zip	:	12754-1704
Country	:	US
Telephone Number	:	631-766-5215
Fax Number	:

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	:	631-766-5215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINE SACHAKOV
Credential	:	PMHNP-BC
Telephone Number	:	631-766-5215

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/04/2021

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