Individual
KELLY SASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 ROUTE 111, SMITHTOWN, NY 11787-3754
(631) 920-8351
Mailing address
11 ROUTE 111, SMITHTOWN, NY 11787-3754
(631) 920-8351
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
667614
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403199
NY
Other
Enumeration date
08/06/2020
Last updated
11/09/2020
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