Provider Demographics
NPI:1114176518
Name:HUNT, SANDRA A (MS, SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:HUNT
Suffix:
Gender:F
Credentials:MS, SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GLENCAIRN CT
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3914
Mailing Address - Country:US
Mailing Address - Phone:315-516-5694
Mailing Address - Fax:
Practice Address - Street 1:25 LOON DR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1536
Practice Address - Country:US
Practice Address - Phone:207-729-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1376235Z00000X
NY012054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433017800Medicaid