Provider Demographics
NPI:1780395202
Name:RODRIGUEZ-CALIXTO, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:RODRIGUEZ-CALIXTO
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 1:575 W 183RD ST APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8602
Mailing Address - Country:US
Mailing Address - Phone:718-316-8417
Mailing Address - Fax:
Practice Address - Street 1:575 W 183RD ST APT 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8602
Practice Address - Country:US
Practice Address - Phone:718-316-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1666844221OtherOTHER