Provider Demographics
NPI:1457499303
Name:INSAIDOO, ROXANNA (REGISTERED PROFESSIO)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNA
Middle Name:
Last Name:INSAIDOO
Suffix:
Gender:F
Credentials:REGISTERED PROFESSIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2530
Mailing Address - Country:US
Mailing Address - Phone:631-521-3387
Mailing Address - Fax:631-206-0537
Practice Address - Street 1:1545 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2530
Practice Address - Country:US
Practice Address - Phone:631-521-3387
Practice Address - Fax:631-206-0537
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445095-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice