Provider Demographics
NPI:1023606050
Name:HERNANDEZ, ASHLEY SARAH (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SARAH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 40TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-4011
Mailing Address - Country:US
Mailing Address - Phone:646-342-1820
Mailing Address - Fax:
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1660
Practice Address - Country:US
Practice Address - Phone:917-310-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046542-01225100000X
CT12898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist