MEDICARE: MRS. SANDRA C. LAJEUNE N.P.

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	363LA2200X	Adult Health Nurse Practitioner	F305483-1	NY

General Provider Information

NPI Number	:	1841596962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA C. LAJEUNE N.P.

Provider Business Mailing Address
First Line	:	3035 GRAND AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4337
Country	:	US
Telephone Number	:	718-283-8696
Fax Number	:	718-635-7424

Provider Business Practice Location Address
First Line	:	3121 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3405
Country	:	US
Telephone Number	:	718-283-8696
Fax Number	:	718-635-7424

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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