Individual provider Active NPI

Jennifer Sanford, N.P.

  • Pediatric Nurse Practitioner
  • Patchogue, NY
National Provider Identifier
1194046946
Registry record updated Feb 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
381624 Issued in NY
Practice address
155 E Woodside Ave Ste B
Patchogue, NY 11772-1421
Phone
(631) 758-6565
Fax
(631) 758-6568
NPI assigned
Jun 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 381624 NY Primary

Addresses

Primary practice location

155 E Woodside Ave Ste B
Patchogue, NY 11772-1421

Mailing address

155 E Woodside Ave Ste B
Patchogue, NY 11772-1421
Phone (631) 758-6565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
381624NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Veritas Medical Care LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739059200000",
    "number": "1194046946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 E WOODSIDE AVE STE B",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721421",
            "telephone_number": "631-758-6565",
            "fax_number": "631-758-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 E WOODSIDE AVE STE B",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721421",
            "telephone_number": "631-758-6565",
            "fax_number": "631-758-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANFORD",
        "first_name": "JENNIFER",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-16",
        "last_updated": "2025-02-09",
        "certification_date": "2025-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "381624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.