Provider Demographics
NPI:1043459969
Name:SANFORD, MARY (MSED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DELAFIELD ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1749
Mailing Address - Country:US
Mailing Address - Phone:845-431-8800
Mailing Address - Fax:845-483-5675
Practice Address - Street 1:115 DELAFIELD ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1749
Practice Address - Country:US
Practice Address - Phone:845-431-8800
Practice Address - Fax:845-483-5675
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007616-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist