Provider Demographics
NPI:1386001618
Name:MANNIX, SALLY E (LPN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:E
Last Name:MANNIX
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 1:8 LILLY CT
Mailing Address - Street 2:PO BOX 182
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1910
Mailing Address - Country:US
Mailing Address - Phone:631-835-8580
Mailing Address - Fax:
Practice Address - Street 1:8 LILLY CT
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1910
Practice Address - Country:US
Practice Address - Phone:631-835-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308992-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse