Provider Demographics
NPI:1437241643
Name:SALANDY, MARY AGATHA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:AGATHA
Last Name:SALANDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4442 WILDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1113
Mailing Address - Country:US
Mailing Address - Phone:718-325-1437
Mailing Address - Fax:
Practice Address - Street 1:JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES
Practice Address - Street 2:120 W. 57 STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-582-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily