Provider Demographics
NPI:1275819997
Name:WALDMAN, SANDRA FREILICH
Entity Type:Individual
Prefix:MR
First Name:SANDRA
Middle Name:FREILICH
Last Name:WALDMAN
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 1:3100 DENTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5115
Mailing Address - Country:US
Mailing Address - Phone:516-546-2035
Mailing Address - Fax:
Practice Address - Street 1:4 SUMMIT LANE
Practice Address - Street 2:SUMMIT LANE SCHOOL
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-520-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003494-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist