Doctor Name: | MRS. SANDRA SHIVAMBER |
NPI Number: | 1265741292 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 335980 |
Business Practice Address: | 1991 Marcus Ave Suite M107 Lake Success, NY - 11042 |
Business Phone Number: | 5162222288 |
Business Fax Number: | 5167450976 |
Mailing Address: | 1991 Marcus Ave, M107 LAKE SUCCESS |
State: | NY |
Postal Code: | 11042 |
Phone Number: | 5162222288 |
Fax Number: | 5167450976 |
NPI Enumeration Date: | 09/24/2010 |
NPI Last Update Date: | 09/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 335980 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |