Provider Demographics
NPI:1861639064
Name:SANON, NANCY (ANP, FNP)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:
Last Name:SANON
Suffix:
Gender:F
Credentials:ANP, FNP
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:SANON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP, FNP-BC
Mailing Address - Street 1:1074 PENINSULA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1542
Mailing Address - Country:US
Mailing Address - Phone:646-438-0038
Mailing Address - Fax:
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:516-445-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-10
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3033741261QH0100X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service