MEDICARE: MS. JACQUELINE SALOMEA SARANTIS RN

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	251330-1	NY

General Provider Information

NPI Number	:	1659305621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE SALOMEA SARANTIS RN

Provider Business Mailing Address
First Line	:	306 DELANCEY AVE
Second Line	:
City	:	MAMARONECK
State	:	NY
Zip	:	10543-2515
Country	:	US
Telephone Number	:	914-381-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 RIVERSIDE DR
Second Line	:	SUITE 1C
City	:	NEW YORK
State	:	NY
Zip	:	10024-3710
Country	:	US
Telephone Number	:	917-687-2607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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