Provider Demographics
NPI:1932462439
Name:SANDERS, KRISTEN P (MS, ED)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:P
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6620
Mailing Address - Country:US
Mailing Address - Phone:718-775-0099
Mailing Address - Fax:
Practice Address - Street 1:2286 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6620
Practice Address - Country:US
Practice Address - Phone:718-775-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499097111174400000X
174400000X
NY358779091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist