Healthcare Provider Details

I. General information

NPI: 1699911784
Provider Name (Legal Business Name): SARAH BRAVO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STUYVESANT OVAL APT MA
NEW YORK NY
10009-2400
US

IV. Provider business mailing address

6 STUYVESANT OVAL APT MA
NEW YORK NY
10009-2400
US

V. Phone/Fax

Practice location:
  • Phone: 989-948-3189
  • Fax:
Mailing address:
  • Phone: 989-948-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number056.009404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: