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General NPI Number Information
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NPI Number | 1073036505
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Entity Type | Individual
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Provider Name | MCKINLEY SLEDGE JR. NP
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Gender | Male
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 201 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301
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Country | US
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Telephone | 718-815-3155
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Fax |
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Provider Business Mailing Address
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Address Line | 273 W LAKE AVE
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City | RAHWAY
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State | NJ
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Zip | 07065-3016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402220
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License Number State | NY
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