Healthcare Provider Details

I. General information

NPI: 1861672883
Provider Name (Legal Business Name): MS. AMY L SADLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 HOLDER PARK DR
MIMS FL
32754-2510
US

IV. Provider business mailing address

4021 HOLDER PARK DR
MIMS FL
32754-2510
US

V. Phone/Fax

Practice location:
  • Phone: 321-264-4214
  • Fax: 321-264-4214
Mailing address:
  • Phone: 321-264-4214
  • Fax: 321-264-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: