Healthcare Provider Details

I. General information

NPI: 1962474254
Provider Name (Legal Business Name): SANDRA O DEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 TOWN CENTER DR
ORANGE CITY FL
32763-8361
US

IV. Provider business mailing address

947 TOWN CENTER DR
ORANGE CITY FL
32763-8361
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-0075
  • Fax: 386-917-0655
Mailing address:
  • Phone: 386-917-0075
  • Fax: 386-917-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME96074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: