Healthcare Provider Details

I. General information

NPI: 1992930499
Provider Name (Legal Business Name): SANJIV FITZ-MORRIS GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MANGOUSTINE AVE STE 100B
SANFORD FL
32771-1004
US

IV. Provider business mailing address

305 N MANGOUSTINE AVE STE 100B
SANFORD FL
32771-1004
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-7821
  • Fax:
Mailing address:
  • Phone: 407-323-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME121713
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number280652
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086P0122X
TaxonomyPhysician Nutrition Specialist (Surgery)
License NumberME121713
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME121713
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME121713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: