Provider Demographics
NPI:1558025486
Name:EDALATI, SAPIR (DNP PMHNP)
Entity Type:Individual
Prefix:
First Name:SAPIR
Middle Name:
Last Name:EDALATI
Suffix:
Gender:F
Credentials:DNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PARK ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1124
Mailing Address - Country:US
Mailing Address - Phone:516-851-5870
Mailing Address - Fax:
Practice Address - Street 1:926 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3913
Practice Address - Country:US
Practice Address - Phone:718-875-6900
Practice Address - Fax:718-875-6999
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779480363LP0808X
NY403879363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health