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General NPI Number Information
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NPI Number | 1548524754
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Entity Type | Individual
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Provider Name | SANDEE JUNGBLUT R.N., M.S.,N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 257 E MIDDLE COUNTRY RD
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City | SMITHTOWN
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State | NY
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Zip | 11787-2807
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Country | US
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Telephone | 631-724-4664
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Fax | 631-360-7880
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Provider Business Mailing Address
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Address Line | 58 WOODLAND RD POB 201
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City | MILLER PLACE
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State | NY
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Zip | 11764-1944
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Country | US
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Telephone | 631-928-8775
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F340205-1
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License Number State | NY
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