Provider Demographics
NPI:1770892812
Name:ALBERT, SANDRA GRACE
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GRACE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:GRACE
Other - Last Name:SHABRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:195 US HIGHWAY 46 STE 101
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-970-9412
Mailing Address - Fax:
Practice Address - Street 1:195 US HIGHWAY 46 STE 101
Practice Address - Street 2:
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-970-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
056582Medicare PIN