Healthcare Provider Details

I. General information

NPI: 1457264434
Provider Name (Legal Business Name): SANDRA ABDELMALEK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 GREENWOOD BLVD
LAKE MARY FL
32746
US

IV. Provider business mailing address

1070 GREENWOOD BLVD
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 647-771-7353
  • Fax:
Mailing address:
  • Phone: 647-771-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC7060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: