Provider Demographics
NPI:1588006035
Name:SANSON, STEPHANIE (AUD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SANSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21033 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1949
Mailing Address - Country:US
Mailing Address - Phone:718-631-8899
Mailing Address - Fax:718-631-4401
Practice Address - Street 1:21033 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1949
Practice Address - Country:US
Practice Address - Phone:718-631-8899
Practice Address - Fax:718-631-4401
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD 687231H00000X
NY002521-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist