Provider Demographics
NPI:1790327096
Name:GARRAWAY-PAYNES, SADJADA K (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SADJADA
Middle Name:K
Last Name:GARRAWAY-PAYNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SADJADA
Other - Middle Name:K
Other - Last Name:GARRAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15601 N CONDUIT AVE APT B19
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4349
Mailing Address - Country:US
Mailing Address - Phone:917-283-7370
Mailing Address - Fax:
Practice Address - Street 1:15601 N CONDUIT AVE APT B19
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4349
Practice Address - Country:US
Practice Address - Phone:917-283-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse