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NPI Code Detail

MEDICARE: MRS. SANDRA WADE-JOHNSON

MEDICARE: MRS. SANDRA WADE-JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse598861NY

General Provider Information

NPI Number : 1558946558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA WADE-JOHNSON
Provider Business Mailing Address
First Line : 787 KING ST
Second Line :
City : RYE BROOK
State : NY
Zip : 10573-1225
Country : US
Telephone Number : 914-937-5800
Fax Number :
Provider Business Practice Location Address
First Line : 787 KING ST
Second Line :
City : RYE BROOK
State : NY
Zip : 10573-1225
Country : US
Telephone Number : 914-937-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 08/02/2021

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Directions to “ MRS. SANDRA WADE-JOHNSON ” Practice Location

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