Healthcare Provider Details

I. General information

NPI: 1902302748
Provider Name (Legal Business Name): SANDHILL PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21758 STATE ROAD 54
LUTZ FL
33549-6921
US

IV. Provider business mailing address

21758 STATE ROAD 54
LUTZ FL
33549-6921
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-6070
  • Fax: 813-563-6040
Mailing address:
  • Phone: 813-563-6070
  • Fax: 813-563-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY J MASTERMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 813-563-6070