Doctor Name: | MS. SANDRA B WILSON |
NPI Number: | 1134295876 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | F400715 |
Business Practice Address: | 189 Wheatly Road Ahrc Nassau County Brookville, NY - 11545 |
Business Phone Number: | 5166864400 |
Business Fax Number: | 5166864425 |
Mailing Address: | 23 Turkey Lane, COLD SPRING HARBOR |
State: | NY |
Postal Code: | 11724 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/27/2006 |
NPI Last Update Date: | 07/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | F400715 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |