Provider Demographics
NPI:1518415710
Name:SAGDATI, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SAGDATI
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 1:341 HAMILTON AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3590
Mailing Address - Country:US
Mailing Address - Phone:203-964-6652
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE
Practice Address - Street 2:#340A,
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1933
Practice Address - Country:US
Practice Address - Phone:914-428-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant