Provider Demographics
NPI:1316084635
Name:SANGUEDOLCE, MARY (MPT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:SANGUEDOLCE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1312
Mailing Address - Country:US
Mailing Address - Phone:516-334-2041
Mailing Address - Fax:
Practice Address - Street 1:168 CHERRY LN
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1741
Practice Address - Country:US
Practice Address - Phone:516-622-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics