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NPI Code Detail

MEDICARE: SANDRA BOROVICKA I

MEDICARE:   SANDRA  BOROVICKA I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistCL1003854OH

General Provider Information

NPI Number : 1336569003
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA BOROVICKA I
Provider Business Mailing Address
First Line : 3213 MONTCLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-4121
Country : US
Telephone Number : 216-749-8553
Fax Number : 216-351-0180
Provider Business Practice Location Address
First Line : 3213 MONTCLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-4121
Country : US
Telephone Number : 216-749-8553
Fax Number : 216-351-6488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2014
Last Update Date : 04/22/2014

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Directions to “ SANDRA BOROVICKA I ” Practice Location

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