Active NPI
Sandra Lutzen-Medina, LMT, WHE
- Health Educator
- Stony Brook, NY
National Provider Identifier
1518336411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 010705-1
- Practice address
- 17 Nadworny LN
Stony Brook, NY 11790-2100 - Phone
- (631) 678-2122
- NPI assigned
- Sep 21, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 010705-1 | NY | Primary |
| Massage Therapist | 225700000X | 010705-1 | NY |
Addresses
Primary practice location
17 Nadworny LN
Stony Brook, NY 11790-2100
Mailing address
17 Nadworny LN
Stony Brook, NY 11790-2100
Phone (631) 678-2122
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010705-1 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485302400000",
"number": "1518336411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 NADWORNY LN",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117902100",
"telephone_number": "631-678-2122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 NADWORNY LN",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117902100",
"telephone_number": "631-678-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZEN-MEDINA",
"first_name": "SANDRA",
"credential": "LMT, WHE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-21",
"last_updated": "2017-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NY",
"license": "010705-1",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "010705-1",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.