Provider Demographics
NPI:1710185285
Name:CLAUD, SAUNDRA L (RN)
Entity Type:Individual
Prefix:MS
First Name:SAUNDRA
Middle Name:L
Last Name:CLAUD
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:PO BOX 1609
Mailing Address - Street 2:396 N MAGEE STREET
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-1609
Mailing Address - Country:US
Mailing Address - Phone:631-283-4551
Mailing Address - Fax:
Practice Address - Street 1:1095 CUSTER AVE
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-3376
Practice Address - Country:US
Practice Address - Phone:631-765-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4041841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619832Medicaid