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Individual
SANDRA MACKINNON PERDEK
Active
Individual
SANDRA MACKINNON PERDEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
302354
NY
363LF0000X
Family Nurse Practitioner
Primary
333880
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092603
GHI-HMO
NY
01
—
000490314003
BLUE SHIELD
NY
01
—
050806000037
FIDELIS CARE
NY
01
—
7599225
GHI-PPO
NY
01
—
788114
MVP
NY
Enumeration date
07/11/2006
Last updated
06/05/2014
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