Provider Demographics
NPI:1710033428
Name:DELALVE MESIDOR, SANDRA A (REGISTERED PROFESSIO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:DELALVE MESIDOR
Suffix:
Gender:F
Credentials:REGISTERED PROFESSIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WALL STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-943-0998
Mailing Address - Fax:
Practice Address - Street 1:DAYTOP VILLAGE INC SPRINGWOOD
Practice Address - Street 2:190 FOX HOLLOW ROAD
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5701831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse