Provider Demographics
NPI:1588679294
Name:TACCAD-REYES, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:TACCAD-REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1108
Practice Address - Country:US
Practice Address - Phone:518-382-8350
Practice Address - Fax:518-382-0345
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213288207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01724616Medicaid
NY200202OtherSENIOR WHOLE HEALTH
NY000401461005OtherBSNENY
NY062AN1OtherEMPIRE BC
NY603335OtherMVP-ENDOCRINOLOGY
NY5666441OtherAETNA
NY10020322OtherCDPHP
NY603336OtherMVP
NY67895OtherGHI/HMO
NY070119000049OtherFIDELIS
NY603336OtherMVP
NY01724616Medicaid