Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305109-1 | NY |
NPI | 1003161183 |
---|---|
Provider Name | Sandra Thomas |
First Address | Middle Island, NY 11953-1705 |
Second Address | East Setauket, NY 11733-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 26/01/2016 |