Provider Demographics
NPI:1376872234
Name:AZRAK, MILDRED JANETTE (MS SPED)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:JANETTE
Last Name:AZRAK
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3983
Mailing Address - Country:US
Mailing Address - Phone:347-838-1797
Mailing Address - Fax:
Practice Address - Street 1:138 COMMODORE DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3983
Practice Address - Country:US
Practice Address - Phone:347-838-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor