MEDICARE: MS. SANDRA ANNE LANDERS LCSW

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	1041C0700X	Clinical Social Worker	SW 5153	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z027P	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1871770701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA ANNE LANDERS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 494081
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33949-4080
Country	:	US
Telephone Number	:	954-668-7689
Fax Number	:	888-821-8320

Provider Business Practice Location Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT F
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:	954-676-8860
Fax Number	:	888-821-8320

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	07/29/2021

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