Provider Demographics
NPI:1194087361
Name:FAJARDO, SANDRA C (MS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WYNGATE DR E
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1404
Mailing Address - Country:US
Mailing Address - Phone:516-599-3187
Mailing Address - Fax:
Practice Address - Street 1:805 WYNGATE DR E
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1404
Practice Address - Country:US
Practice Address - Phone:516-599-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist