Provider Demographics
NPI:1811552052
Name:SANDBERG, YDINE ELENA (MA SLP-CCC)
Entity Type:Individual
Prefix:
First Name:YDINE
Middle Name:ELENA
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 KEAWE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2486
Mailing Address - Country:US
Mailing Address - Phone:619-818-2287
Mailing Address - Fax:
Practice Address - Street 1:16-680 KEAAU PAHOA RD
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8142
Practice Address - Country:US
Practice Address - Phone:808-313-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist