Provider Demographics
NPI:1548233604
Name:SANDS, STEPHEN ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:SANDS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 63RD ST
Mailing Address - Street 2:APARTMENT 5N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7928
Mailing Address - Country:US
Mailing Address - Phone:917-435-2400
Mailing Address - Fax:
Practice Address - Street 1:641 LEXINGTON AVE
Practice Address - Street 2:MEMORIAL SLOAN KETTERING CANCER CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4503
Practice Address - Country:US
Practice Address - Phone:646-888-0023
Practice Address - Fax:646-888-0160
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013296103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01891583Medicaid
NYS58558Medicare UPIN
NYV93631Medicare ID - Type Unspecified