Healthcare Provider Details

I. General information

NPI: 1669648077
Provider Name (Legal Business Name): STANLEY SACK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WHITE ST SUITE 103
KEY WEST FL
33040-3328
US

IV. Provider business mailing address

1201 WHITE ST SUITE 103
KEY WEST FL
33040-3328
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-7337
  • Fax: 305-295-0597
Mailing address:
  • Phone: 305-295-7337
  • Fax: 305-295-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 86306
License Number StateFL

VIII. Authorized Official

Name: DR. STANLEY SINCLAIR SACK
Title or Position: PRESIDENT
Credential: MD
Phone: 305-292-0598