Active NPI
Sandra Davenport, P.A.
- Physician Assistant
- New York, NY
National Provider Identifier
1487801155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012715
- Practice address
- 1 Penn PLZ # 6195
New York, NY 10119-0002 - Phone
- (212) 757-8686
- NPI assigned
- Aug 25, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012715 | NY | Primary |
Addresses
Primary practice location
1 Penn PLZ # 6195
New York, NY 10119-0002
Mailing address
1 Penn PLZ # 6195
New York, NY 10119-0002
Phone (212) 757-8686
Other practice location 1
244 5th Ave # 2515
New York, NY 10001-7604
Phone (212) 757-8686
Other practice location 2
1A whispering court
elemam physician pc
dix hills, NY 11746
Phone (631) 491-9121
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012715 | NY | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elemam Physician PC | 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.
-
- Physical Medicine & Rehabilitation Physician
- Dix Hills, NY
- NPI 1245432285
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575763200000",
"number": "1487801155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PENN PLZ # 6195",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101190002",
"telephone_number": "212-757-8686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PENN PLZ # 6195",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101190002",
"telephone_number": "212-757-8686"
}
],
"practiceLocations": [
{
"address_1": "244 5th Ave # 2515",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100017604",
"country_code": "US",
"telephone_number": "212-757-8686",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1A whispering court",
"address_2": "elemam physician pc",
"address_purpose": "LOCATION",
"city": "dix hills",
"state": "NY",
"postal_code": "11746",
"country_code": "US",
"telephone_number": "631-491-9121",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVENPORT",
"first_name": "SANDRA",
"name_prefix": "Ms.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-25",
"last_updated": "2019-12-08",
"certification_date": "2019-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.