Provider Demographics
NPI:1760635718
Name:SACKEY, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SACKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 GRAND CONCOURSE
Mailing Address - Street 2:APT 3-J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-3800
Mailing Address - Country:US
Mailing Address - Phone:347-503-9627
Mailing Address - Fax:
Practice Address - Street 1:2051 GRAND CONCOURSE
Practice Address - Street 2:APT 3-J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-3800
Practice Address - Country:US
Practice Address - Phone:347-503-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282969164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse