Provider Demographics
NPI:1801257076
Name:SANJURJO, YANIRA
Entity type:Individual
Prefix:
First Name:YANIRA
Middle Name:
Last Name:SANJURJO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YANIRA
Other - Middle Name:
Other - Last Name:CASANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2514
Mailing Address - Country:US
Mailing Address - Phone:631-264-4278
Mailing Address - Fax:
Practice Address - Street 1:239 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2514
Practice Address - Country:US
Practice Address - Phone:631-264-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325075164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse