Provider Demographics
NPI:1972375590
Name:SANDOVAL, MARIA D
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:SANDOVAL
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 1:7226 BURCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1114
Mailing Address - Country:US
Mailing Address - Phone:347-489-6959
Mailing Address - Fax:
Practice Address - Street 1:7226 BURCHELL AVE
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1114
Practice Address - Country:US
Practice Address - Phone:347-489-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty