Provider Demographics
NPI:1447454376
Name:SASITORN, LUCKSANA T (CRNA)
Entity type:Individual
Prefix:MS
First Name:LUCKSANA
Middle Name:T
Last Name:SASITORN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TRENCHARD ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2247
Mailing Address - Country:US
Mailing Address - Phone:914-969-0867
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9510
Practice Address - Fax:718-920-9582
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247294367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered