Healthcare Provider Details

I. General information

NPI: 1770727166
Provider Name (Legal Business Name): SANDRA FARRELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 LONGFELLOW AVE
BRONX NY
10460-5431
US

IV. Provider business mailing address

PO BOX 659
BRONX NY
10472-0659
US

V. Phone/Fax

Practice location:
  • Phone: 718-617-9213
  • Fax:
Mailing address:
  • Phone: 718-617-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335458
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9360500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: