Healthcare Provider Details

I. General information

NPI: 1639198518
Provider Name (Legal Business Name): BILLY SAND PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LEFFERTS AVE 1D
BROOKLYN NY
11225-4348
US

IV. Provider business mailing address

725 166TH ST 4C
WHITESTONE NY
11357-2061
US

V. Phone/Fax

Practice location:
  • Phone: 917-613-9920
  • Fax: 718-613-4381
Mailing address:
  • Phone: 718-613-4471
  • Fax: 718-631-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number014110-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: