Healthcare Provider Details

I. General information

NPI: 1689954646
Provider Name (Legal Business Name): SANDRA ANNE KUPPRAT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 24TH ST
NEW YORK NY
10010-4019
US

IV. Provider business mailing address

530 E 84TH ST APT. 4M
NEW YORK NY
10028-7319
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-6000
  • Fax:
Mailing address:
  • Phone: 917-405-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: