Provider Demographics
NPI:1003863424
Name:BROWN-TRUTER, SANDRA (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BROWN-TRUTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34-11 VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-5121
Mailing Address - Country:US
Mailing Address - Phone:631-979-0922
Mailing Address - Fax:
Practice Address - Street 1:220 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2420
Practice Address - Country:US
Practice Address - Phone:631-979-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466308-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q55807Medicare UPIN
NY1300G1Medicare PIN