Provider Demographics
NPI:1457556896
Name:PRIOR, SANDRA K (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:K
Last Name:PRIOR
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 1:47 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1322
Mailing Address - Country:US
Mailing Address - Phone:631-549-9653
Mailing Address - Fax:
Practice Address - Street 1:47 SHORE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1322
Practice Address - Country:US
Practice Address - Phone:631-549-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182351163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00991795Medicaid