NPIMap

Organization Active NPI

Sardonyx Wellness LCSW PLLC

  • Clinical Social Worker
  • West Sayville, NY
National Provider Identifier
1477210698
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SARDONYX WELLNESS LCSW PLLC
Practice address
93 Main St Ste 1J
West Sayville, NY 11796-1832
Phone
(631) 509-2575
Fax
(631) 256-9353
NPI assigned
Nov 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Authorized official

Name
Mrs. Melissa Elliott-Brogan, LCSWNPI 1720352164
Title
Owner
Phone
(631) 509-2575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

93 Main St Ste 1J
West Sayville, NY 11796-1832

Mailing address

PO Box 822
Sayville, NY 11782-0822
Phone (631) 509-2575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241119000823 NY Part B Supplier - Clinic/Group Practice 2668907304 Receives reassigned benefits from 1 practitioner
Practice locations: West Sayville, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1477210698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 822",
            "city": "SAYVILLE",
            "state": "NY",
            "postal_code": "117820822",
            "telephone_number": "631-509-2575",
            "fax_number": "631-256-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 MAIN ST STE 1J",
            "city": "WEST SAYVILLE",
            "state": "NY",
            "postal_code": "117961832",
            "telephone_number": "631-509-2575",
            "fax_number": "631-256-9353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SARDONYX WELLNESS LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT-BROGAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-509-2575",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Sayville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.