Healthcare Provider Details

I. General information

NPI: 1750382057
Provider Name (Legal Business Name): STEPHEN EUGENE SANDRONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ROBERTS AVE
TALLAHASSEE FL
32310-5007
US

IV. Provider business mailing address

2911 ROBERTS AVE
TALLAHASSEE FL
32310-5007
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-1543
  • Fax:
Mailing address:
  • Phone: 850-644-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME44083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: