Provider Demographics
NPI:1013066778
Name:SAND, SHARA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHARA
Middle Name:
Last Name:SAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W END AVE APT 8F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3562
Mailing Address - Country:US
Mailing Address - Phone:212-666-5376
Mailing Address - Fax:212-666-5376
Practice Address - Street 1:900 W END AVE APT 8F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3562
Practice Address - Country:US
Practice Address - Phone:212-666-5376
Practice Address - Fax:212-666-5376
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012174-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist