Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174V00000X | Clinical Ethicist | 431022 | NY |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 431022 | NY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | F331615-1 | NY |
NPI | 1871525535 |
---|---|
Provider Name | Dr. Renee Mcleod-Sordjan |
First Address | Miller Place, NY 11764-3200 |
Second Address | Valley Stream, NY 11580-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P21908 | (02) | NY |