Provider Demographics
NPI:1538298914
Name:NEGRON, SANDRA D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:D
Last Name:NEGRON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 SAUNDERS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2039
Mailing Address - Country:US
Mailing Address - Phone:718-459-6891
Mailing Address - Fax:718-275-1646
Practice Address - Street 1:6344 SAUNDERS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2039
Practice Address - Country:US
Practice Address - Phone:718-459-6891
Practice Address - Fax:718-275-1646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012777103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742194Medicaid
NY02690Medicare ID - Type UnspecifiedGHI-MEDICARE
NY01742194Medicaid