Provider Demographics
NPI:1366687170
Name:WILLIAMS, SANDRA FAY
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:FAY
Last Name:WILLIAMS
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 1:184 PROSPECT PARK W # A-4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5268
Mailing Address - Country:US
Mailing Address - Phone:347-385-3887
Mailing Address - Fax:718-788-2037
Practice Address - Street 1:184 PROSPECT PARK W # A-4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5268
Practice Address - Country:US
Practice Address - Phone:347-385-3887
Practice Address - Fax:718-788-2037
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061132-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist