Provider Demographics
NPI:1952657140
Name:SAUCO, LISA ANN
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:SAUCO
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 1:2240 84TH STREET
Mailing Address - Street 2:APT. D3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3370
Mailing Address - Country:US
Mailing Address - Phone:718-541-9335
Mailing Address - Fax:
Practice Address - Street 1:2240 84TH STREET
Practice Address - Street 2:APT. D3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3370
Practice Address - Country:US
Practice Address - Phone:718-541-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist