Healthcare Provider Details

I. General information

NPI: 1750542908
Provider Name (Legal Business Name): SANDRA ANN EDWARDS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MILLFORD LN
CENTEREACH NY
11720-2828
US

IV. Provider business mailing address

208 STUDENT HEALTH STADIUM RD
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4397
  • Fax:
Mailing address:
  • Phone: 631-632-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: