Provider Demographics
NPI:1811267982
Name:TACY, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JOHN STREET
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12123
Mailing Address - Country:US
Mailing Address - Phone:518-207-2624
Mailing Address - Fax:518-766-9548
Practice Address - Street 1:4 JOHN STREET
Practice Address - Street 2:
Practice Address - City:NASSAU
Practice Address - State:NY
Practice Address - Zip Code:12123
Practice Address - Country:US
Practice Address - Phone:518-207-2624
Practice Address - Fax:518-766-9548
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501619-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409145Medicaid