Healthcare Provider Details

I. General information

NPI: 1427320720
Provider Name (Legal Business Name): TAMARA SAGO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 SILVER LN
OLD BRIDGE NJ
08857-3338
US

IV. Provider business mailing address

247 SILVER LN
OLD BRIDGE NJ
08857-3338
US

V. Phone/Fax

Practice location:
  • Phone: 347-452-8389
  • Fax:
Mailing address:
  • Phone: 347-452-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15530800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: