Healthcare Provider Details

I. General information

NPI: 1992469027
Provider Name (Legal Business Name): NIC SANABRIA MS, MT-BC, NRMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 LEE RD
ORLANDO FL
32810-5621
US

IV. Provider business mailing address

870 BROADSTONE WAY APT 104
ALTAMONTE SPRINGS FL
32714-1645
US

V. Phone/Fax

Practice location:
  • Phone: 631-255-9831
  • Fax:
Mailing address:
  • Phone: 631-255-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: