Provider Demographics
NPI:1760786719
Name:SANDE, CAREN DEBRA (MS CCC/LSP)
Entity Type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:DEBRA
Last Name:SANDE
Suffix:
Gender:F
Credentials:MS CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4735
Mailing Address - Country:US
Mailing Address - Phone:631-585-7920
Mailing Address - Fax:
Practice Address - Street 1:68 OPAL ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4735
Practice Address - Country:US
Practice Address - Phone:631-585-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist