Provider Demographics
NPI:1477029387
Name:ARISTIDE, SARAH (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ARISTIDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:ARISTIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 BRENTWOOD RD APT 24
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8000
Mailing Address - Country:US
Mailing Address - Phone:516-263-9227
Mailing Address - Fax:
Practice Address - Street 1:21 BRENTWOOD RD APT 24
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8000
Practice Address - Country:US
Practice Address - Phone:516-263-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid