Healthcare Provider Details

I. General information

NPI: 1699686683
Provider Name (Legal Business Name): MICAELA STEFANIA SANDOVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 BEACON ST APT 12
BROOKLINE MA
02446-5677
US

IV. Provider business mailing address

1077 BEACON ST APT 12
BROOKLINE MA
02446-5677
US

V. Phone/Fax

Practice location:
  • Phone: 617-888-5819
  • Fax:
Mailing address:
  • Phone: 617-888-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: