Provider Demographics
NPI:1508390758
Name:PORTELA, SANDRA
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:
Last Name:PORTELA
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 1:6 CARUSO LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2421
Mailing Address - Country:US
Mailing Address - Phone:516-801-0440
Mailing Address - Fax:
Practice Address - Street 1:6 CARUSO LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-2421
Practice Address - Country:US
Practice Address - Phone:516-801-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist