Provider Demographics
NPI:1134626559
Name:CORDOVA, SARA ASHLEY
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:CORDOVA
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 1:60 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3712
Mailing Address - Country:US
Mailing Address - Phone:917-714-6100
Mailing Address - Fax:
Practice Address - Street 1:2748 OCEAN AVE APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4735
Practice Address - Country:US
Practice Address - Phone:646-237-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator