Provider Demographics
NPI:1033457577
Name:SPARANDERA, DINA MARIE
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:MARIE
Last Name:SPARANDERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 PETER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4225
Mailing Address - Country:US
Mailing Address - Phone:917-364-8847
Mailing Address - Fax:
Practice Address - Street 1:158 PETER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4225
Practice Address - Country:US
Practice Address - Phone:917-364-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist