Provider Demographics
NPI:1518202951
Name:GOLDING, RENAYE SANCHIA (RN)
Entity Type:Individual
Prefix:
First Name:RENAYE
Middle Name:SANCHIA
Last Name:GOLDING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6044
Mailing Address - Country:US
Mailing Address - Phone:917-684-6261
Mailing Address - Fax:
Practice Address - Street 1:376 WESTSIDE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-6044
Practice Address - Country:US
Practice Address - Phone:917-684-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310715164W00000X
NY781136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1518202951Medicaid