Healthcare Provider Details

I. General information

NPI: 1114748571
Provider Name (Legal Business Name): SABRINA NUGDALLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 NY-25A SUITE C
WADING RIVER NY
11792
US

IV. Provider business mailing address

8 CLUNAN DR
CORAM NY
11727-3505
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-5858
  • Fax:
Mailing address:
  • Phone: 631-838-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354725
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: