Provider Demographics
NPI:1760119630
Name:SEARS, CRYSTAL S
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:SEARS
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 1:8705 BEDELL LN APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3261
Mailing Address - Country:US
Mailing Address - Phone:917-414-1361
Mailing Address - Fax:
Practice Address - Street 1:8705 BEDELL LN APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3261
Practice Address - Country:US
Practice Address - Phone:917-414-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist