Provider Demographics
NPI:1124099155
Name:SEDORE, DINA (NP)
Entity type:Individual
Prefix:MS
First Name:DINA
Middle Name:
Last Name:SEDORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5801
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:914-593-7881
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-593-7872
Practice Address - Fax:914-593-7881
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303605363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02730505Medicaid
NY303605OtherNYS LICENSE
NY02730505Medicaid
NY1563G1Medicare PIN