Provider Demographics
NPI:1104508050
Name:BIRD, SAYODA SADEEK (LICENSE PRACTICAL N)
Entity type:Individual
Prefix:MISS
First Name:SAYODA
Middle Name:SADEEK
Last Name:BIRD
Suffix:
Gender:F
Credentials:LICENSE PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3217
Mailing Address - Country:US
Mailing Address - Phone:347-400-0687
Mailing Address - Fax:
Practice Address - Street 1:38 OVERLOOK ST PH
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3217
Practice Address - Country:US
Practice Address - Phone:347-400-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339526-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty