Provider Demographics
NPI:1659635944
Name:SLEEPER, CARLY (RPA-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SLEEPER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3904
Mailing Address - Country:US
Mailing Address - Phone:518-963-4275
Mailing Address - Fax:
Practice Address - Street 1:39 FARRELL RD
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996-3904
Practice Address - Country:US
Practice Address - Phone:518-963-4275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015659363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical