Provider Demographics
NPI:1285034819
Name:RENATA SANDERS MD PLLC
Entity Type:Organization
Organization Name:RENATA SANDERS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-355-0312
Mailing Address - Street 1:445 CENTRAL AVE
Mailing Address - Street 2:SUITE 331
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2001
Mailing Address - Country:US
Mailing Address - Phone:917-355-0312
Mailing Address - Fax:
Practice Address - Street 1:445 CENTRAL AVE
Practice Address - Street 2:SUITE 331
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2001
Practice Address - Country:US
Practice Address - Phone:917-355-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2642762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty