Provider Demographics
NPI:1205447190
Name:SANSOM, ASHLEY (DNP)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:SANSOM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 5TH AVE STE 1402-373
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5010
Mailing Address - Country:US
Mailing Address - Phone:929-445-8258
Mailing Address - Fax:877-345-6901
Practice Address - Street 1:347 5TH AVE STE 1402-373
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:929-777-0173
Practice Address - Fax:877-929-2508
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779628163W00000X, 163WG0000X
NY403503363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice