Provider Demographics
NPI:1639324957
Name:SUNGAMENDOZA, MARIA CARMEL
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMEL
Last Name:SUNGAMENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEL
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:91 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1401
Mailing Address - Country:US
Mailing Address - Phone:516-579-0923
Mailing Address - Fax:516-579-0923
Practice Address - Street 1:91 AVIS DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1401
Practice Address - Country:US
Practice Address - Phone:516-579-0923
Practice Address - Fax:516-579-0923
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010524225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics