Healthcare Provider Details

I. General information

NPI: 1649541459
Provider Name (Legal Business Name): SANDRA SANON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14524 221ST ST
SPRINGFIELD GARDENS NY
11413-3435
US

IV. Provider business mailing address

14524 221ST ST
SPRINGFIELD GARDENS NY
11413-3435
US

V. Phone/Fax

Practice location:
  • Phone: 347-768-5639
  • Fax:
Mailing address:
  • Phone: 347-768-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number495492
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number495492-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: