Healthcare Provider Details

I. General information

NPI: 1235732827
Provider Name (Legal Business Name): SARAH PHAN DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FULTON ST
BROOKLYN NY
11217-1517
US

IV. Provider business mailing address

77 CLINTON AVE
BROOKLYN NY
11205-2302
US

V. Phone/Fax

Practice location:
  • Phone: 718-596-9800
  • Fax:
Mailing address:
  • Phone: 718-834-2981
  • Fax: 718-834-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number802683
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF383400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: