Healthcare Provider Details

I. General information

NPI: 1497619829
Provider Name (Legal Business Name): MICHELLE SANDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 W MONTAUK HWY
WEST BABYLON NY
11704-8219
US

IV. Provider business mailing address

295 CENTRAL AVE
BOHEMIA NY
11716-3157
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-7373
  • Fax: 631-792-1985
Mailing address:
  • Phone: 516-994-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number019950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: