Provider Demographics
NPI:1740532951
Name:SANDOVAL, ELLEN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:50 DAYTON LANE, SUITE 202
Mailing Address - Street 2:THE WESTCHESTER MEDICAL PRACTICE PC
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:35 SOUTH RIVERSIDE AVENUE
Practice Address - Street 2:THE WESTCHESTER MEDICAL PRATICE PC
Practice Address - City:CROTON-ON-HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520
Practice Address - Country:US
Practice Address - Phone:914-271-2424
Practice Address - Fax:914-271-2551
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2024-04-24
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Provider Licenses
StateLicense IDTaxonomies
NY176447-01208000000X
NY176447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics