Provider Demographics
NPI:1790818987
Name:SAHA, SNIGDHA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SNIGDHA
Middle Name:
Last Name:SAHA
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 1:3417 VAN WIE DR E
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8911
Mailing Address - Country:US
Mailing Address - Phone:315-638-3253
Mailing Address - Fax:315-453-2966
Practice Address - Street 1:4753 STONEDALE DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2528
Practice Address - Country:US
Practice Address - Phone:315-453-2966
Practice Address - Fax:315-453-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1834971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859907Medicaid