Healthcare Provider Details

I. General information

NPI: 1134578859
Provider Name (Legal Business Name): SANDRA NAIRUBY DE JESUS MEDINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15077 S DIXIE HWY
MIAMI FL
33176-7930
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 786-293-3200
  • Fax: 305-232-9082
Mailing address:
  • Phone: 786-293-3200
  • Fax: 305-232-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME138843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: