Provider Demographics
NPI:1538422464
Name:BIRD-SINCLAIR, GWENDOLYN MARIE (TEACHER)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:BIRD-SINCLAIR
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:MARIE
Other - Last Name:BIRD-SINCLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TEACHER
Mailing Address - Street 1:19 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2316
Mailing Address - Country:US
Mailing Address - Phone:347-721-0718
Mailing Address - Fax:
Practice Address - Street 1:LIVINGSTON STREET SUITE 101
Practice Address - Street 2:THERACARE 111
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY826297981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist