Provider Demographics
NPI:1093873101
Name:RICHARDSON, SALLY ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:72 FULTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3651
Mailing Address - Country:US
Mailing Address - Phone:516-385-2920
Mailing Address - Fax:516-385-2293
Practice Address - Street 1:72 FULTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3651
Practice Address - Country:US
Practice Address - Phone:516-385-2920
Practice Address - Fax:516-385-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF304105-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health