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General NPI Number Information
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NPI Number | 1578332904
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Entity Type | Individual
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Provider Name | SANDRA C FANNING PH.D
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 5 W 19TH ST RM 3R
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City | NEW YORK
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State | NY
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Zip | 10011-4238
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Country | US
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Telephone | 786-244-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 5 W 19TH ST RM 3R
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City | NEW YORK
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State | NY
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Zip | 10011-4238
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Country | US
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Telephone | 786-244-7711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 0810007917
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License Number State | VA
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