Provider Demographics
NPI:1619344652
Name:SANO, YESSICA M
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:M
Last Name:SANO
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 1:2615 GRAND CONCOURSE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4431
Mailing Address - Country:US
Mailing Address - Phone:646-342-0494
Mailing Address - Fax:
Practice Address - Street 1:2615 GRAND CONCOURSE APT 3F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4431
Practice Address - Country:US
Practice Address - Phone:646-342-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator