Provider Demographics
NPI:1548023971
Name:FARAH, SANDRA MARIA (FNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIA
Last Name:FARAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BLEEKER AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4545
Mailing Address - Country:US
Mailing Address - Phone:914-374-6915
Mailing Address - Fax:
Practice Address - Street 1:102 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3711
Practice Address - Country:US
Practice Address - Phone:914-315-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349590-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily