Provider Demographics
NPI:1497230643
Name:NOEL, SAPPHIRE ELISSA
Entity Type:Individual
Prefix:
First Name:SAPPHIRE
Middle Name:ELISSA
Last Name:NOEL
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 1:284 EASTERN PKWY APT 6A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1171
Mailing Address - Country:US
Mailing Address - Phone:305-890-9477
Mailing Address - Fax:
Practice Address - Street 1:13802 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2642
Practice Address - Country:US
Practice Address - Phone:718-206-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY743356163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)