=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023725629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE SANDOR PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2022
-----------------------------------------------------
Last Update Date | 11/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | GOLDENS BRIDGE SHOPPING CENTER SUITE 203
-----------------------------------------------------
City | GOLDENS BRIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-325-0740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 SAIL HARBOUR DR
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06784-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-325-0740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 013784
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------