Provider Demographics
NPI:1134107600
Name:SANCHEZ-LATREILLE, MYRNA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:A
Last Name:SANCHEZ-LATREILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYRNA
Other - Middle Name:A
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:183 PARK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953
Mailing Address - Country:US
Mailing Address - Phone:518-483-0482
Mailing Address - Fax:518-483-6727
Practice Address - Street 1:183 PARK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1238
Practice Address - Country:US
Practice Address - Phone:518-483-0482
Practice Address - Fax:518-483-6727
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184388207RH0002X, 207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421618Medicaid
NYB70244OtherALICE HYDE MEDICAL CENTER
NYB70244OtherALICE HYDE MEDICAL CENTER
NYF17146Medicare UPIN