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General NPI Number Information
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NPI Number | 1972972826
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Entity Type | Individual
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Provider Name | SABRINA ALEXIS BACCHUS P.A.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 237 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4513
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Country | US
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Telephone | 516-584-6400
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Fax | 516-584-6401
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Provider Business Mailing Address
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Address Line | 8623 239TH ST
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City | BELLEROSE
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State | NY
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Zip | 11426-1254
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Country | US
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Telephone | 347-880-0088
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019011
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License Number State | NY
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