Healthcare Provider Details

I. General information

NPI: 1538893722
Provider Name (Legal Business Name): SANDRA LAWRENCE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CENTRAL PARK BLVD N STE 225
BOCA RATON FL
33428-1705
US

IV. Provider business mailing address

PO BOX 970845
BOCA RATON FL
33497-0845
US

V. Phone/Fax

Practice location:
  • Phone: 954-696-5623
  • Fax: 561-756-8969
Mailing address:
  • Phone: 954-696-5623
  • Fax: 561-756-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LAWRENCE
Title or Position: OWNER
Credential: MD
Phone: 954-696-5623