Provider Demographics
NPI:1629471172
Name:STONEY - CAMPBELL, SASHA-KAYE
Entity Type:Individual
Prefix:
First Name:SASHA-KAYE
Middle Name:
Last Name:STONEY - CAMPBELL
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 1:363 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4015
Mailing Address - Country:US
Mailing Address - Phone:914-433-3904
Mailing Address - Fax:
Practice Address - Street 1:363 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4015
Practice Address - Country:US
Practice Address - Phone:914-433-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319835164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse