Provider Demographics
NPI:1033435177
Name:MASSEY/BEHRBOM, SARA BETH (LPN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:MASSEY/BEHRBOM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:WHITAKER/MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:318 RT 32 SOUTH NEW PALTZ NY 12561
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-706-2573
Mailing Address - Fax:
Practice Address - Street 1:RT 32 NEW PALTZ NY 12561
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-706-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299767164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse