Provider Demographics
NPI:1568884583
Name:DAVID, SANDRA ANTONINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANTONINE
Last Name:DAVID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ANTONINE
Other - Last Name:CELESTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1160 E 86TH ST
Mailing Address - Street 2:FL. 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4737
Mailing Address - Country:US
Mailing Address - Phone:516-503-3642
Mailing Address - Fax:
Practice Address - Street 1:1160 E 86TH ST
Practice Address - Street 2:FL. 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4737
Practice Address - Country:US
Practice Address - Phone:516-503-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1712684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist