Healthcare Provider Details

I. General information

NPI: 1124469549
Provider Name (Legal Business Name): SARAH DALY STOLLDORF CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2013
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

400 E 71ST ST APT. 12-O
NEW YORK NY
10021-4808
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8152
  • Fax:
Mailing address:
  • Phone: 804-398-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001196447
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number534361-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101125
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: