Provider Demographics
NPI:1801064993
Name:SABU, ANNIE KORUTHU (RN, MS, NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:KORUTHU
Last Name:SABU
Suffix:
Gender:F
Credentials:RN, MS, NP-C
Other - Prefix:MISS
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:615 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4271
Mailing Address - Country:US
Mailing Address - Phone:516-327-6093
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:NORTHSHORE UNIVERSITY HOSPITAL
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4271
Practice Address - Country:US
Practice Address - Phone:516-327-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304453-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health