Provider Demographics
NPI:1174849699
Name:LUSSI, SANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LUSSI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 KATONAH AVE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2123
Mailing Address - Country:US
Mailing Address - Phone:914-767-3303
Mailing Address - Fax:
Practice Address - Street 1:171 KATONAH AVE
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2123
Practice Address - Country:US
Practice Address - Phone:914-767-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001193-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist