Provider Demographics
NPI:1891480802
Name:SABIO, JUSTYANN BRYNN MIRAS
Entity type:Individual
Prefix:
First Name:JUSTYANN BRYNN
Middle Name:MIRAS
Last Name:SABIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W 211TH ST BSMT SUPT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5916
Mailing Address - Country:US
Mailing Address - Phone:360-206-0954
Mailing Address - Fax:
Practice Address - Street 1:550 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3203
Practice Address - Country:US
Practice Address - Phone:212-943-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY834301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse