Provider Demographics
NPI:1750854519
Name:SANCHEZ, MITZU SANDRA (SLP)
Entity type:Individual
Prefix:MS
First Name:MITZU
Middle Name:SANDRA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5406
Mailing Address - Country:US
Mailing Address - Phone:845-549-6564
Mailing Address - Fax:
Practice Address - Street 1:124 MEADOW HILL RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3878
Practice Address - Country:US
Practice Address - Phone:845-568-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028309-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist