Healthcare Provider Details

I. General information

NPI: 1487909560
Provider Name (Legal Business Name): SANDRA E. COLON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 E SILVER SPRINGS BLVD STE 400
OCALA FL
34470-3354
US

IV. Provider business mailing address

5664 SW 60TH AVE
OCALA FL
34474-5677
US

V. Phone/Fax

Practice location:
  • Phone: 352-236-8300
  • Fax: 352-236-8390
Mailing address:
  • Phone: 352-291-5555
  • Fax: 352-291-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: