=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518415710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE SAGDATI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2016
-----------------------------------------------------
Last Update Date | 09/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 N CENTRAL AVE #340A,
-----------------------------------------------------
City | HARTSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10530-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-428-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 341 HAMILTON AVE UNIT B
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-3590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-964-6652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------