Provider Demographics
NPI:1326294026
Name:MCFADDEN-SCOTT, SALLY AGNES
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:AGNES
Last Name:MCFADDEN-SCOTT
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 1:21 JONES PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3541
Mailing Address - Country:US
Mailing Address - Phone:914-462-8896
Mailing Address - Fax:
Practice Address - Street 1:21 JONES PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3541
Practice Address - Country:US
Practice Address - Phone:914-462-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247299-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019879206Medicare PIN