MEDICARE: SANDRA VIDAL

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	235Z00000X	Speech-Language Pathologist	SA7040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346611548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA VIDAL

Provider Business Mailing Address
First Line	:	9242 NORTHLAKE PKWY
Second Line	:	APT 107
City	:	ORLANDO
State	:	FL
Zip	:	32827-5721
Country	:	US
Telephone Number	:	407-721-3708
Fax Number	:

Provider Business Practice Location Address
First Line	:	9242 NORTHLAKE PKWY
Second Line	:	APT 107
City	:	ORLANDO
State	:	FL
Zip	:	32827-5721
Country	:	US
Telephone Number	:	407-721-3708
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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Directions to “ SANDRA VIDAL ” Practice Location

Language	Start Address	Practice Location

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