Healthcare Provider Details

I. General information

NPI: 1740678366
Provider Name (Legal Business Name): MS. ANGELA SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 CLEVELAND ST
BROOKLYN NY
11208-1014
US

IV. Provider business mailing address

163 CLEVELAND ST
BROOKLYN NY
11208-1014
US

V. Phone/Fax

Practice location:
  • Phone: 347-613-4392
  • Fax:
Mailing address:
  • Phone: 347-613-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0067801
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0067801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: