Provider Demographics
NPI:1215285309
Name:ASIEDU, SANDRA DEBRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEBRA
Last Name:ASIEDU
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 1:1065 GERARD AVE
Mailing Address - Street 2:118 A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8845
Mailing Address - Country:US
Mailing Address - Phone:646-361-8249
Mailing Address - Fax:
Practice Address - Street 1:1065 GERARD AVE
Practice Address - Street 2:118 A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8845
Practice Address - Country:US
Practice Address - Phone:646-361-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse