Healthcare Provider Details

I. General information

NPI: 1225940539
Provider Name (Legal Business Name): SANDRA HENAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S HARBOR CITY BLVD STE C
MELBOURNE FL
32901-1500
US

IV. Provider business mailing address

1064 TEVIS ST SE
PALM BAY FL
32909-5805
US

V. Phone/Fax

Practice location:
  • Phone: 321-372-1132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA110191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: