Healthcare Provider Details

I. General information

NPI: 1174427173
Provider Name (Legal Business Name): SANDRA FAITH PORTUGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 EVERGREEN PL APT 109
DAVIE FL
33324-4303
US

IV. Provider business mailing address

9411 EVERGREEN PL APT 109
DAVIE FL
33324-4303
US

V. Phone/Fax

Practice location:
  • Phone: 954-667-5459
  • Fax: 954-667-5459
Mailing address:
  • Phone: 954-667-5459
  • Fax: 954-667-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: