Provider Demographics
NPI:1609004431
Name:CORRO-MOY, SANDRA JACQUELINE (CCC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JACQUELINE
Last Name:CORRO-MOY
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 94TH ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6983
Mailing Address - Country:US
Mailing Address - Phone:917-930-8198
Mailing Address - Fax:
Practice Address - Street 1:201 W 94TH ST APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6983
Practice Address - Country:US
Practice Address - Phone:917-930-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019108-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist