Provider Demographics
NPI:1326863515
Name:SENSORY BRAIN LLC
Entity type:Organization
Organization Name:SENSORY BRAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JINNERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-202-9850
Mailing Address - Street 1:URB BAIROA GOLDEN GATE II
Mailing Address - Street 2:Q8 CALLE G
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1146
Mailing Address - Country:US
Mailing Address - Phone:787-202-9850
Mailing Address - Fax:
Practice Address - Street 1:BO. CANABONCITO, SECTOR LA SIERRA, CARR. 172 KM.20.6
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-317-3984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine