Healthcare Provider Details

I. General information

NPI: 1548210008
Provider Name (Legal Business Name): SANDRA CAULFIELD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 DEL PRADO BLVD N STE 2
CAPE CORAL FL
33909-5287
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-656-6300
  • Fax: 239-656-6765
Mailing address:
  • Phone: 239-656-6300
  • Fax: 239-656-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: