Provider Demographics
NPI:1093835407
Name:FABRICATORE, SANDRA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:FABRICATORE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6709
Mailing Address - Country:US
Mailing Address - Phone:914-594-4333
Mailing Address - Fax:914-594-3807
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:MUNGER PAVILION, ROOM 140
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1652
Practice Address - Country:US
Practice Address - Phone:914-594-4333
Practice Address - Fax:914-594-3807
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381675-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics