Provider Demographics
NPI:1669061198
Name:SABU, REENA (NP)
Entity type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:SABU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:REENA
Other - Middle Name:
Other - Last Name:SABU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:464 WOOLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2113
Mailing Address - Country:US
Mailing Address - Phone:718-581-6685
Mailing Address - Fax:
Practice Address - Street 1:464 WOOLLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2113
Practice Address - Country:US
Practice Address - Phone:718-581-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310028-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health