Provider Demographics
NPI:1336694702
Name:BERAN-SANDY, NATASHA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:BERAN-SANDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 VANDERVEER ST
Mailing Address - Street 2:QUEENS VILLAGE
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1731
Mailing Address - Country:US
Mailing Address - Phone:347-922-2093
Mailing Address - Fax:
Practice Address - Street 1:9402 VANDERVEER ST
Practice Address - Street 2:QUEENS VILLAGE
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1731
Practice Address - Country:US
Practice Address - Phone:347-922-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312676164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse