Provider Demographics
NPI:1124295159
Name:HUGHES, SANDRA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEAN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:90 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1935
Mailing Address - Country:US
Mailing Address - Phone:910-393-9190
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2949
Practice Address - Country:US
Practice Address - Phone:914-771-7070
Practice Address - Fax:914-771-7073
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics