Healthcare Provider Details

I. General information

NPI: 1689768491
Provider Name (Legal Business Name): DENISE SANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE MARIE ORTEGA MD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SE OCEAN BLVD STE 203
STUART FL
34996-3301
US

IV. Provider business mailing address

2220 SE OCEAN BLVD STE 203
STUART FL
34996-3301
US

V. Phone/Fax

Practice location:
  • Phone: 772-872-6913
  • Fax: 772-872-6924
Mailing address:
  • Phone: 772-872-6913
  • Fax: 772-872-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME97068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: