Provider Demographics
NPI:1467764027
Name:DESIMONE, SANDRA MARIE PAGAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE PAGAN
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1053 SAW MILL RIVER RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1048
Mailing Address - Country:US
Mailing Address - Phone:845-638-3072
Mailing Address - Fax:
Practice Address - Street 1:1053 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1048
Practice Address - Country:US
Practice Address - Phone:845-638-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY020120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist