Provider Demographics
NPI:1518324656
Name:DEKAMS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEKAMS
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 1:72 FARMEDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5202
Mailing Address - Country:US
Mailing Address - Phone:516-490-3301
Mailing Address - Fax:516-490-3303
Practice Address - Street 1:72 FARMEDGE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5202
Practice Address - Country:US
Practice Address - Phone:516-490-3301
Practice Address - Fax:516-490-3303
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY897261141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist