Provider Demographics
NPI:1639956477
Name:SANDERS, SEBASTIAN G (LPN)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:G
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 171ST ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5432
Mailing Address - Country:US
Mailing Address - Phone:917-306-6622
Mailing Address - Fax:
Practice Address - Street 1:8914 171ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5432
Practice Address - Country:US
Practice Address - Phone:917-306-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse