Provider Demographics
NPI:1609508241
Name:EXILUS, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:EXILUS
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 1:3614 AVENUE K APT B2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4305
Mailing Address - Country:US
Mailing Address - Phone:929-620-8143
Mailing Address - Fax:
Practice Address - Street 1:3614 AVENUE K APT B2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4305
Practice Address - Country:US
Practice Address - Phone:929-620-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty