Healthcare Provider Details

I. General information

NPI: 1538112123
Provider Name (Legal Business Name): SANDRA J ELLIOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ATLANTIC BLVD
POMPANO BCH FL
33060
US

IV. Provider business mailing address

PO BOX 862851
ORLANDO FL
32886-2851
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-5413
  • Fax: 954-784-9249
Mailing address:
  • Phone: 954-847-4273
  • Fax: 954-847-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME61256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: