Healthcare Provider Details

I. General information

NPI: 1508482308
Provider Name (Legal Business Name): MADISON SAUNDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W GRANADA BLVD STE 1
ORMOND BEACH FL
32174-9406
US

IV. Provider business mailing address

725 W GRANADA BLVD STE 1
ORMOND BEACH FL
32174-9406
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-2770
  • Fax: 386-673-2760
Mailing address:
  • Phone: 407-637-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME169979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: