Provider Demographics
NPI:1922604388
Name:MULLOKANDOVA, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MULLOKANDOVA
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 1:14416 72ND DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2404
Mailing Address - Country:US
Mailing Address - Phone:646-578-2986
Mailing Address - Fax:
Practice Address - Street 1:14416 72ND DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2404
Practice Address - Country:US
Practice Address - Phone:646-578-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst