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General NPI Number Information
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NPI Number | 1801165931
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Entity Type | Individual
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Provider Name | SANDRA BRACERO M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 270 CENTRE AVENUE
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2401
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Country | US
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Telephone | 914-576-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 230 PELHAM ROAD APT. 5R
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2546
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Country | US
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Telephone | 914-826-7454
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 021294
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License Number State | NY
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