Provider Demographics
NPI:1801165931
Name:BRACERO, SANDRA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:BRACERO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:BRACERO OCASIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:230 PELHAM ROAD
Mailing Address - Street 2:APT. 5R
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-2546
Mailing Address - Country:US
Mailing Address - Phone:914-826-7454
Mailing Address - Fax:
Practice Address - Street 1:270 CENTRE AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-2401
Practice Address - Country:US
Practice Address - Phone:914-576-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist