Basic Information
| Provider Information | |||||||||
| NPI: | 1588679294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TACCAD-REYES | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 113 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183828350 | ||||||||
| FaxNumber: | 5183820345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 213288 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 070119000049 | 01 | NY | FIDELIS | OTHER | 10020322 | 01 | NY | CDPHP | OTHER | 67895 | 01 | NY | GHI/HMO | OTHER | 603336 | 01 | NY | MVP | OTHER | 200202 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 5666441 | 01 | NY | AETNA | OTHER | 603335 | 01 | NY | MVP-ENDOCRINOLOGY | OTHER | 000401461005 | 01 | NY | BSNENY | OTHER | 01724616 | 05 | NY | MEDICAID | 062AN1 | 01 | NY | EMPIRE BC | OTHER |