Provider Demographics
NPI:1285066852
Name:BASTIDAS, SANDRA PATRICIA (RN, ANP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:PATRICIA
Last Name:BASTIDAS
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25W DUNES LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1407
Mailing Address - Country:US
Mailing Address - Phone:516-423-6655
Mailing Address - Fax:
Practice Address - Street 1:25W DUNES LN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1407
Practice Address - Country:US
Practice Address - Phone:516-423-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554556163W00000X
NY306608363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health