Provider Demographics
NPI:1922650712
Name:PUERTO, SANDRA KAY (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:PUERTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EMERALD LN N
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2043
Mailing Address - Country:US
Mailing Address - Phone:631-408-0090
Mailing Address - Fax:
Practice Address - Street 1:28 EMERALD LN N
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2043
Practice Address - Country:US
Practice Address - Phone:631-408-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480034163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice