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General NPI Number Information
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NPI Number | 1861305179
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Entity Type | Individual
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Provider Name | SANDRA MARIN MSN
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Gender | Female
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Dates
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Enumeration Date | 09/26/2026
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Last Update Date | 09/26/2026
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Provider Practice Location Address
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Address Line | 15811 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11365-3085
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Country | US
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Telephone | 347-933-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 15811 JEWEL AVE
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City | FLUSHING
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State | NY
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Zip | 11365-3085
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Country | US
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Telephone |
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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 | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number | 695216
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 695216
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License Number State | NY
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