Healthcare Provider Details

I. General information

NPI: 1932339348
Provider Name (Legal Business Name): MICHAEL R SANDS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HEMPSTEAD TPKE STE 200
BETHPAGE NY
11714-5700
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 328
GREAT NECK NY
11021-5329
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-1900
  • Fax: 516-731-7302
Mailing address:
  • Phone: 516-233-2484
  • Fax: 516-304-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: