Provider Demographics
NPI:1346450699
Name:HOLLOWAY, SANDRA WENDY (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:WENDY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 RIVERSIDE DR W
Mailing Address - Street 2:APT 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7010
Mailing Address - Country:US
Mailing Address - Phone:212-928-1383
Mailing Address - Fax:
Practice Address - Street 1:15620 RIVERSIDE DR W
Practice Address - Street 2:APT 12B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7010
Practice Address - Country:US
Practice Address - Phone:212-928-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY504262Medicare UPIN