Healthcare Provider Details

I. General information

NPI: 1235515347
Provider Name (Legal Business Name): SANDEEP KAUR F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

IV. Provider business mailing address

111 CLOCK TOWER CMNS
BREWSTER NY
10509-4055
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-7828
  • Fax: 845-794-3347
Mailing address:
  • Phone: 845-279-5187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: