Provider Demographics
NPI:1437145877
Name:MAMIS, SANDRA S (RPA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:MAMIS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3701
Mailing Address - Country:US
Mailing Address - Phone:845-561-1565
Mailing Address - Fax:845-561-1578
Practice Address - Street 1:400 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3701
Practice Address - Country:US
Practice Address - Phone:845-561-1565
Practice Address - Fax:845-561-1578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002898363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS70020Medicare UPIN
NY0F2111Medicare ID - Type Unspecified