Healthcare Provider Details

I. General information

NPI: 1548570724
Provider Name (Legal Business Name): SANDRA NASSER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DEBORAH DR
WESTHAMPTON BEACH NY
11978-1450
US

IV. Provider business mailing address

12 DEBORAH DR
WESTHAMPTON BEACH NY
11978-1450
US

V. Phone/Fax

Practice location:
  • Phone: 516-398-3702
  • Fax:
Mailing address:
  • Phone: 516-398-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number624540-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number624540-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: