Provider Demographics
NPI:1235386830
Name:EINFELDT, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:EINFELDT
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 1:32 E POND LN
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1303
Mailing Address - Country:US
Mailing Address - Phone:631-325-0216
Mailing Address - Fax:
Practice Address - Street 1:32 E POND LN
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1303
Practice Address - Country:US
Practice Address - Phone:631-325-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY394969163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse