Healthcare Provider Details

I. General information

NPI: 1487562575
Provider Name (Legal Business Name): SANDRA GORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 SARNO RD
MELBOURNE FL
32935-3077
US

IV. Provider business mailing address

1045 LOCUST AVE NW
PALM BAY FL
32907-7945
US

V. Phone/Fax

Practice location:
  • Phone: 321-608-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA20978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: