Provider Demographics
NPI:1053790592
Name:SARVAIDEO, JILL (FNP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SARVAIDEO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LEIF BLVD
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1316
Mailing Address - Country:US
Mailing Address - Phone:845-729-3935
Mailing Address - Fax:
Practice Address - Street 1:96 LEIF BLVD
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1316
Practice Address - Country:US
Practice Address - Phone:845-729-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335111-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily