Provider Demographics
NPI:1003196007
Name:SANSONE, KRISTINA (MA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:SANSONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WILLOWBROOK ROAD
Mailing Address - Street 2:PS 54 CHARLES W. LENG
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-698-0600
Mailing Address - Fax:718-698-1736
Practice Address - Street 1:1060 WILLOWBROOK ROAD
Practice Address - Street 2:PS 54 CHARLES W. LENG
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-698-0600
Practice Address - Fax:718-698-1736
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist