Provider Demographics
NPI:1306470273
Name:SURGEON, SANDY GLANSILDA (RN)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:GLANSILDA
Last Name:SURGEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:GLANSILDA
Other - Last Name:SURGEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:10 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3447
Mailing Address - Country:US
Mailing Address - Phone:914-751-4736
Mailing Address - Fax:
Practice Address - Street 1:1075 BROADWAY
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2346
Practice Address - Country:US
Practice Address - Phone:914-741-4736
Practice Address - Fax:914-773-6165
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY469073-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management