Healthcare Provider Details

I. General information

NPI: 1497883383
Provider Name (Legal Business Name): CATHERINE MARY SANCHEZ DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SKIDMORE PL
WEST ISLIP NY
11795-4336
US

IV. Provider business mailing address

9 SKIDMORE PL
WEST ISLIP NY
11795-4336
US

V. Phone/Fax

Practice location:
  • Phone: 631-539-8741
  • Fax:
Mailing address:
  • Phone: 631-539-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number835053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: