Healthcare Provider Details

I. General information

NPI: 1235715095
Provider Name (Legal Business Name): INA SANDELI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

17231 WOODBINE WAY
FORT MYERS FL
33967-2580
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-1471
  • Fax:
Mailing address:
  • Phone: 347-756-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOP61521223
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: