Provider Demographics
NPI:1659305621
Name:SARANTIS, JACQUELINE SALOMEA (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SALOMEA
Last Name:SARANTIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DELANCEY AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2515
Mailing Address - Country:US
Mailing Address - Phone:914-381-5436
Mailing Address - Fax:
Practice Address - Street 1:125 RIVERSIDE DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3710
Practice Address - Country:US
Practice Address - Phone:917-687-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251330-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health