Healthcare Provider Details

I. General information

NPI: 1952683807
Provider Name (Legal Business Name): SANDRA LEE GLAIZE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S SWOOPE AVE
MAITLAND FL
32751-5704
US

IV. Provider business mailing address

4133 CONWAY PLACE CIR
ORLANDO FL
32812-7990
US

V. Phone/Fax

Practice location:
  • Phone: 407-851-0140
  • Fax: 407-851-0140
Mailing address:
  • Phone: 407-851-0140
  • Fax: 407-851-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: