Provider Demographics
NPI:1346638038
Name:SANDERS, STELLA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:
Last Name:SANDERS
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:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-0627
Mailing Address - Country:US
Mailing Address - Phone:845-467-1862
Mailing Address - Fax:
Practice Address - Street 1:19 RICHARDSON CT
Practice Address - Street 2:UNIT 22
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2276
Practice Address - Country:US
Practice Address - Phone:845-467-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305499-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY305499-1OtherLPN