MEDICARE: ASHLEY SARAH HERNANDEZ DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	046542-01	NY
2	225100000X	Physical Therapist	12898	CT

General Provider Information

NPI Number	:	1023606050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SARAH HERNANDEZ DPT

Provider Business Mailing Address
First Line	:	4725 40TH ST APT 2A
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-4011
Country	:	US
Telephone Number	:	646-342-1820
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 QUEENS BLVD
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1660
Country	:	US
Telephone Number	:	917-310-2772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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Directions to “ ASHLEY SARAH HERNANDEZ DPT” Practice Location

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