Provider Demographics
NPI:1982241543
Name:SANCHEZ, SUSANA ALTAGRACIA
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:ALTAGRACIA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 FONTAINEBLEAU BLVD APT 417
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5559
Mailing Address - Country:US
Mailing Address - Phone:786-449-4699
Mailing Address - Fax:
Practice Address - Street 1:9440 FONTAINEBLEAU BLVD APT 417
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5559
Practice Address - Country:US
Practice Address - Phone:786-449-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist