Healthcare Provider Details

I. General information

NPI: 1154942944
Provider Name (Legal Business Name): HANNA SANDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-8460
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5400
  • Fax: 631-444-7538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number208600000
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number343199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: