Healthcare Provider Details

I. General information

NPI: 1053428383
Provider Name (Legal Business Name): SANDRA Y MITJANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 E 8TH AVE STE E
HIALEAH FL
33013
US

IV. Provider business mailing address

2843 SW 174TH AVE
MIRAMAR FL
33029-5549
US

V. Phone/Fax

Practice location:
  • Phone: 305-769-5601
  • Fax: 305-769-0473
Mailing address:
  • Phone: 305-769-5601
  • Fax: 305-769-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME40785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: