Provider Demographics
NPI:1972911691
Name:HOLNESS, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HOLNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 DEHAVEN DR
Mailing Address - Street 2:APT 5H
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1347
Mailing Address - Country:US
Mailing Address - Phone:646-427-9474
Mailing Address - Fax:
Practice Address - Street 1:98 DEHAVEN DR
Practice Address - Street 2:APT 5H
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1347
Practice Address - Country:US
Practice Address - Phone:646-427-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012407314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility