Provider Demographics
NPI:1205199486
Name:SMELLIE, SANJA
Entity Type:Individual
Prefix:
First Name:SANJA
Middle Name:
Last Name:SMELLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SOUTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3421
Mailing Address - Country:US
Mailing Address - Phone:516-993-8965
Mailing Address - Fax:
Practice Address - Street 1:715 SOUTHERN PKWY
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3421
Practice Address - Country:US
Practice Address - Phone:516-993-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310252164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse