Provider Demographics
NPI:1710503891
Name:POLANCO-DIAZ, SINAI MARISOL
Entity Type:Individual
Prefix:
First Name:SINAI
Middle Name:MARISOL
Last Name:POLANCO-DIAZ
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 1:28 NICHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1510
Mailing Address - Country:US
Mailing Address - Phone:347-780-7612
Mailing Address - Fax:
Practice Address - Street 1:2550 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1261
Practice Address - Country:US
Practice Address - Phone:347-721-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist