1215237581 NPI number — AUDREY CECILE SANGSTER SADAPHAL MD

Table of content: AUDREY CECILE SANGSTER SADAPHAL MD (NPI 1215237581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215237581 NPI number — AUDREY CECILE SANGSTER SADAPHAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANGSTER SADAPHAL
Provider First Name:
AUDREY
Provider Middle Name:
CECILE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANGSTER
Provider Other First Name:
AUDREY
Provider Other Middle Name:
CECILE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215237581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 GEORGIA STREET,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-285-4384
Provider Business Mailing Address Fax Number:
516-285-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 GEORGIA STREET,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-285-4384
Provider Business Practice Location Address Fax Number:
516-285-1909
Provider Enumeration Date:
11/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  166066 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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