1528646296 NPI number — MISS SANIYA DESIREE CARDONA

Table of content: MISS SANIYA DESIREE CARDONA (NPI 1528646296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528646296 NPI number — MISS SANIYA DESIREE CARDONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDONA
Provider First Name:
SANIYA
Provider Middle Name:
DESIREE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528646296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 CEDAR HILL ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-418-2978
Provider Business Mailing Address Fax Number:
866-500-2186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CEDAR HILL ST, SUITE 200 MARLBOROUGH, MA 01752
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-418-2978
Provider Business Practice Location Address Fax Number:
866-500-2186
Provider Enumeration Date:
04/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)