Provider Demographics
NPI:1821384892
Name:AMBATT, SARA JOHN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JOHN
Last Name:AMBATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARAMMA
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:465 SADDLE RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-364-6270
Mailing Address - Fax:
Practice Address - Street 1:465 SADDLE RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:845-364-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY465458-1163W00000X
NYF336670-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse