Provider Demographics
NPI:1437471885
Name:SMITH, SANDRIA
Entity Type:Individual
Prefix:
First Name:SANDRIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GERTS WAY
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-7220
Mailing Address - Country:US
Mailing Address - Phone:646-938-0820
Mailing Address - Fax:
Practice Address - Street 1:20 GERTS WAY
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-7220
Practice Address - Country:US
Practice Address - Phone:646-938-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256659-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY466897-1OtherNEW YORK STATE LICENCE NUMBER
NY466397-1OtherLICENCE