Provider Demographics
NPI:1811279458
Name:BORDENAVE-SANDE, THEA MAE (DO)
Entity type:Individual
Prefix:
First Name:THEA
Middle Name:MAE
Last Name:BORDENAVE-SANDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 VAN DAM ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2023
Mailing Address - Country:US
Mailing Address - Phone:518-587-0801
Mailing Address - Fax:518-587-0849
Practice Address - Street 1:77 VAN DAM ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2023
Practice Address - Country:US
Practice Address - Phone:518-587-0801
Practice Address - Fax:518-587-0849
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY60-270606204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM