Provider Demographics
NPI:1669354874
Name:SANCHEZ, DESARAE
Entity type:Individual
Prefix:
First Name:DESARAE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MCKEE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4824
Mailing Address - Country:US
Mailing Address - Phone:860-992-2983
Mailing Address - Fax:
Practice Address - Street 1:14455 W VAN BUREN ST BLDG A
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9209
Practice Address - Country:US
Practice Address - Phone:623-518-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program