Healthcare Provider Details

I. General information

NPI: 1710593876
Provider Name (Legal Business Name): JESSICA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E 95TH ST
BROOKLYN NY
11236-2006
US

IV. Provider business mailing address

850 E 95TH ST
BROOKLYN NY
11236-2006
US

V. Phone/Fax

Practice location:
  • Phone: 347-957-1282
  • Fax:
Mailing address:
  • Phone: 347-957-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: