MEDICARE: DR. STACEY SANDERS D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	3875	FL
2	213EP1101X	Primary Podiatric Medicine Podiatrist	PO3875	FL

General Provider Information

NPI Number	:	1114999158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY SANDERS D.P.M.

Provider Business Mailing Address
First Line	:	816 MIDDLE ST APT 1
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7107
Country	:	US
Telephone Number	:	239-218-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 MIDDLE ST APT 1
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7107
Country	:	US
Telephone Number	:	239-218-2051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	12/27/2021

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Directions to “ DR. STACEY SANDERS D.P.M.” Practice Location

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