Provider Demographics
NPI:1861242497
Name:DAUSKI, SANDRA BONNIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BONNIE
Last Name:DAUSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1363
Mailing Address - Country:US
Mailing Address - Phone:518-719-3619
Mailing Address - Fax:518-719-3779
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1363
Practice Address - Country:US
Practice Address - Phone:518-719-3619
Practice Address - Fax:518-719-3779
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224557164W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1114056777Medicaid