Provider Demographics
NPI:1629730106
Name:MUKKATT, SANGEETHA LIJU (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANGEETHA
Middle Name:LIJU
Last Name:MUKKATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STRACK DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1596
Mailing Address - Country:US
Mailing Address - Phone:845-831-4800
Mailing Address - Fax:
Practice Address - Street 1:145 HOSNER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6624
Practice Address - Country:US
Practice Address - Phone:184-559-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily