Healthcare Provider Details

I. General information

NPI: 1114126919
Provider Name (Legal Business Name): JAIME E SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

3300 S FISKE BLVD STE 503
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-407-7097
  • Fax: 321-600-2012
Mailing address:
  • Phone: 321-407-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME108792
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME108792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: