Healthcare Provider Details

I. General information

NPI: 1730604646
Provider Name (Legal Business Name): ANDREA SANCLEMENTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 COMMERCE AVE STE 1
RIVERHEAD NY
11901-3105
US

IV. Provider business mailing address

45 RESEARCH WAY STE 105
EAST SETAUKET NY
11733-6401
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-3422
  • Fax:
Mailing address:
  • Phone: 631-675-2125
  • Fax: 631-675-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: