Provider Demographics
NPI:1578182028
Name:BRITO, SANDRA MARIBEL
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIBEL
Last Name:BRITO
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 1:3303 PRINCE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2730
Mailing Address - Country:US
Mailing Address - Phone:718-535-7272
Mailing Address - Fax:
Practice Address - Street 1:3303 PRINCE ST FL 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2730
Practice Address - Country:US
Practice Address - Phone:718-535-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02929344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi