Provider Demographics
NPI:1073179354
Name:SAGAJLLO, JOHN R (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SAGAJLLO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CLINTWOOD DR # D
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3539
Mailing Address - Country:US
Mailing Address - Phone:585-978-6179
Mailing Address - Fax:
Practice Address - Street 1:14 CLINTWOOD DR # D
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3539
Practice Address - Country:US
Practice Address - Phone:585-978-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283595164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse