Provider Demographics
NPI:1124634928
Name:AKHAREYI, SANDRA OMOYE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:OMOYE
Last Name:AKHAREYI
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 1:238 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3411
Mailing Address - Country:US
Mailing Address - Phone:646-204-2342
Mailing Address - Fax:
Practice Address - Street 1:238 HOOVER RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3411
Practice Address - Country:US
Practice Address - Phone:646-204-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5813313Medicaid