Provider Demographics
NPI:1194439380
Name:SABU, JESSICA JACOB (NP, RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JACOB
Last Name:SABU
Suffix:
Gender:
Credentials:NP, RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:281 PHELPS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4005
Mailing Address - Country:US
Mailing Address - Phone:631-422-7676
Mailing Address - Fax:
Practice Address - Street 1:281 PHELPS LN
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4005
Practice Address - Country:US
Practice Address - Phone:631-422-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY774064163W00000X
NY406903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse