Healthcare Provider Details

I. General information

NPI: 1164006862
Provider Name (Legal Business Name): RIVKY SANDEL CPT, BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FOURTH ST
MONROE NY
10950-2064
US

IV. Provider business mailing address

21 FOURTH ST
MONROE NY
10950-2064
US

V. Phone/Fax

Practice location:
  • Phone: 845-629-1212
  • Fax:
Mailing address:
  • Phone: 845-629-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number992075
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberW4S3X9N8
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: