Provider Demographics
NPI:1558614792
Name:HERSHENOV, SARAH BROOKE
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:BROOKE
Last Name:HERSHENOV
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 1:353 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2024
Mailing Address - Country:US
Mailing Address - Phone:516-481-2673
Mailing Address - Fax:
Practice Address - Street 1:353 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2024
Practice Address - Country:US
Practice Address - Phone:516-481-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY359573091174400000X
NY610621122174400000X
NY594134122174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist