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General NPI Number Information
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NPI Number | 1639660277
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Entity Type | Organization
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Legal Business Name | SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 7 FENNELL ST LOWR LEVEL
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City | SKANEATELES
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State | NY
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Zip | 13152
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Country | US
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Telephone | 315-857-5971
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Fax |
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Provider Business Mailing Address
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Address Line | 7 FENNELL ST LOWR LEVEL
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City | SKANEATELES
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State | NY
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Zip | 13152-1196
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Country | US
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Telephone | 315-857-5971
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | OLUMUYIWA ROBBERT GAY
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Credential | MD
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Telephone | 315-857-5971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101416
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 247603
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License Number State | NY
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