Provider Demographics
NPI:1497575583
Name:MICALLEF, SABRINA MADISON
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MADISON
Last Name:MICALLEF
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 1:16047 24TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3942
Mailing Address - Country:US
Mailing Address - Phone:718-813-3035
Mailing Address - Fax:
Practice Address - Street 1:21410 24TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2219
Practice Address - Country:US
Practice Address - Phone:347-321-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician