Healthcare Provider Details

I. General information

NPI: 1306164777
Provider Name (Legal Business Name): MAXIE ANTHONY SANDS BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 2ND ST
POMPANO BEACH FL
33060-4611
US

IV. Provider business mailing address

11031 NE 6TH AVE
MIAMI FL
33161-7182
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-9828
  • Fax: 954-941-9808
Mailing address:
  • Phone: 305-398-6100
  • Fax: 305-757-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: