Provider Demographics
NPI:1033435177
Name:MASSEY, SARA BETH (LPN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:98 E MARKET ST
Mailing Address - Street 2:APARTMENT A14
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1668
Mailing Address - Country:US
Mailing Address - Phone:845-802-3238
Mailing Address - Fax:
Practice Address - Street 1:98 E MARKET ST
Practice Address - Street 2:APARTMENT A14
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1668
Practice Address - Country:US
Practice Address - Phone:845-802-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299767164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse