Provider Demographics
NPI:1518299486
Name:SUNESARA, SABANA R (PA)
Entity Type:Individual
Prefix:
First Name:SABANA
Middle Name:R
Last Name:SUNESARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0658
Mailing Address - Country:US
Mailing Address - Phone:800-345-0064
Mailing Address - Fax:973-251-1109
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:SOUND SHORE MEDICAL CENTER OF WESTCHESTER
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5502
Practice Address - Country:US
Practice Address - Phone:914-632-5000
Practice Address - Fax:973-251-1109
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013099-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant