Provider Demographics
NPI:1427263201
Name:PAZ, SANDRA (CP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W 46TH ST
Mailing Address - Street 2:APARTMENT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-8302
Mailing Address - Country:US
Mailing Address - Phone:212-971-5819
Mailing Address - Fax:914-761-3034
Practice Address - Street 1:875 6TH AVE
Practice Address - Street 2:ROOM 2401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3507
Practice Address - Country:US
Practice Address - Phone:212-971-5819
Practice Address - Fax:914-761-3034
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02127920Medicaid
NY458551OtherVALUE OPTIONS
NY02127920Medicaid
NYVJ447V0221Medicare PIN