Provider Demographics
NPI:1790061323
Name:MAHMUD, SARA NAZ (LPN)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:NAZ
Last Name:MAHMUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 129TH ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2801
Mailing Address - Country:US
Mailing Address - Phone:646-417-2770
Mailing Address - Fax:
Practice Address - Street 1:20514 LINDEN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2900
Practice Address - Country:US
Practice Address - Phone:718-528-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307397-1373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist