Healthcare Provider Details

I. General information

NPI: 1447183801
Provider Name (Legal Business Name): SAND SEA WELLNESS NURSE PRACTITIONERS IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MONTAUK HWY
BLUE POINT NY
11715-1101
US

IV. Provider business mailing address

70 SNEDECOR AVE
BAYPORT NY
11705-1717
US

V. Phone/Fax

Practice location:
  • Phone: 631-319-3453
  • Fax:
Mailing address:
  • Phone: 631-484-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA SANTAMARIA
Title or Position: NURSE PRACTITIONER IN ADULT HEALTH
Credential: AGNP
Phone: 631-484-2739