Provider Demographics
NPI:1720070733
Name:DAVE, SANDRA MARIE (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:DAVE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5028
Mailing Address - Country:US
Mailing Address - Phone:914-633-7200
Mailing Address - Fax:914-633-7217
Practice Address - Street 1:110 LOCKWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5028
Practice Address - Country:US
Practice Address - Phone:914-633-7200
Practice Address - Fax:914-633-7217
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2200986OtherUNITED HEALTHCARE
P2736693OtherOXFORD
NY02292942Medicaid
NY2E7421Medicare ID - Type Unspecified
P68032Medicare UPIN