Provider Demographics
NPI:1538184155
Name:JONES, SADIE (CNM)
Entity type:Individual
Prefix:MS
First Name:SADIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:MOSS JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, LM
Mailing Address - Street 1:42 SPRING VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3319
Mailing Address - Country:US
Mailing Address - Phone:845-765-8272
Mailing Address - Fax:888-841-7754
Practice Address - Street 1:42 SPRING VALLEY ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3319
Practice Address - Country:US
Practice Address - Phone:845-765-8272
Practice Address - Fax:888-841-7754
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001055367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP78351Medicare UPIN
NYP78351Medicare UPIN