Healthcare Provider Details

I. General information

NPI: 1902721178
Provider Name (Legal Business Name): SANDRA GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

V. Phone/Fax

Practice location:
  • Phone: 516-710-5574
  • Fax: 866-305-0477
Mailing address:
  • Phone: 516-710-5574
  • Fax: 866-305-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number085163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: