Healthcare Provider Details

I. General information

NPI: 1497381107
Provider Name (Legal Business Name): SARAH SPADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

106 PINESBRIDGE RD
OSSINING NY
10562-1706
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax:
Mailing address:
  • Phone: 518-281-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF345637-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberF345637-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF345637-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: