MEDICARE: DR. SANDRA I DIAS PH.D.

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	103T00000X	Psychologist	021488	NY

General Provider Information

NPI Number	:	1831555119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA I DIAS PH.D.

Provider Business Mailing Address
First Line	:	159 BLEECKER ST
Second Line	:	MEZZANINE FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10012-1457
Country	:	US
Telephone Number	:	512-417-0167
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 BLEECKER ST
Second Line	:	MEZZANINE FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10012-1457
Country	:	US
Telephone Number	:	512-417-0167
Fax Number	:

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

Provider Enumeration Date	:	01/03/2016
Last Update Date	:	01/22/2016

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