Healthcare Provider Details

I. General information

NPI: 1437241643
Provider Name (Legal Business Name): MARY AGATHA SALANDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES 120 W. 57 STREET
NEW YORK NY
10019
US

IV. Provider business mailing address

4442 WILDER AVE
BRONX NY
10466-1113
US

V. Phone/Fax

Practice location:
  • Phone: 212-582-9100
  • Fax:
Mailing address:
  • Phone: 718-325-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: