Provider Demographics
NPI:1982847653
Name:PLAZA, SALLY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:
Last Name:PLAZA
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 1:1782 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1364
Mailing Address - Country:US
Mailing Address - Phone:845-473-5900
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:1782 SOUTH RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1364
Practice Address - Country:US
Practice Address - Phone:845-473-5900
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse