Provider Demographics
NPI:1548519002
Name:SANDERS, YVROSE M (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:YVROSE
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8308
Mailing Address - Country:US
Mailing Address - Phone:631-993-4001
Mailing Address - Fax:631-328-5330
Practice Address - Street 1:28 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8308
Practice Address - Country:US
Practice Address - Phone:631-993-4001
Practice Address - Fax:631-328-5330
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR05660100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR05660100OtherLICENSE