Healthcare Provider Details

I. General information

NPI: 1790689503
Provider Name (Legal Business Name): SABRINA MANGIARACINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 SHELDON AVE
STATEN ISLAND NY
10312-2644
US

IV. Provider business mailing address

669 SHELDON AVE
STATEN ISLAND NY
10312-2644
US

V. Phone/Fax

Practice location:
  • Phone: 644-640-4335
  • Fax:
Mailing address:
  • Phone: 644-640-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00428400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: