Provider Demographics
NPI:1114788916
Name:ROSAMILIA, SANDRA CHRISTINE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:ROSAMILIA
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 1:48 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1407
Mailing Address - Country:US
Mailing Address - Phone:516-491-1005
Mailing Address - Fax:
Practice Address - Street 1:48 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-1407
Practice Address - Country:US
Practice Address - Phone:516-491-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst