Healthcare Provider Details

I. General information

NPI: 1861305179
Provider Name (Legal Business Name): SANDRA MARIN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15811 JEWEL AVE
FLUSHING NY
11365-3085
US

IV. Provider business mailing address

15811 JEWEL AVE
FLUSHING NY
11365-3085
US

V. Phone/Fax

Practice location:
  • Phone: 347-933-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number695216
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number695216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: