Provider Demographics
NPI:1740707132
Name:SCRIVANO, SARA AMY (DC, MSA)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:AMY
Last Name:SCRIVANO
Suffix:
Gender:F
Credentials:DC, MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2021
Mailing Address - Country:US
Mailing Address - Phone:516-637-4146
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST RM 1012
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2515
Practice Address - Country:US
Practice Address - Phone:917-763-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012928111N00000X
NY006348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor