Provider Demographics
NPI:1063665487
Name:ROSELLI, SARAH KAY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:KAY
Last Name:ROSELLI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8890 COUNTY HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:BLOOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13739
Mailing Address - Country:US
Mailing Address - Phone:607-652-3647
Mailing Address - Fax:
Practice Address - Street 1:8890 COUNTY HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:13739
Practice Address - Country:US
Practice Address - Phone:607-652-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291233-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse