Individual
SALLY SOUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3408 PARK AVE, WANTAGH, NY 11793-3702
(516) 221-2123
Mailing address
3408 PARK AVE, WANTAGH, NY 11793-3702
(516) 320-4206
(888) 524-5729
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
401632
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F401632-1
NY
Other
Enumeration date
11/14/2013
Last updated
10/08/2020
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