Provider Demographics
NPI:1124104260
Name:PRIESTER, SALLY
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ASHFORD AVE. 29 WASHINGTON STREET
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1509
Mailing Address - Country:US
Mailing Address - Phone:787-985-9705
Mailing Address - Fax:787-957-7087
Practice Address - Street 1:ASHFORD AVE. 29 WASHINGTON STREET
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1509
Practice Address - Country:US
Practice Address - Phone:787-985-9705
Practice Address - Fax:787-957-7087
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16480208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR016480OtherLICENSE
PR016480OtherLICENSE