Healthcare Provider Details

I. General information

NPI: 1164359493
Provider Name (Legal Business Name): SANDY IVETTE CORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 RISHLEY RUN WAY
MOUNT DORA FL
32757-8019
US

IV. Provider business mailing address

5453 RISHLEY RUN WAY
MOUNT DORA FL
32757-8019
US

V. Phone/Fax

Practice location:
  • Phone: 321-388-3098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: