Healthcare Provider Details

I. General information

NPI: 1518068154
Provider Name (Legal Business Name): SANDRA SUSAN TORRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 DOCTORS CIR
WILMINGTON NC
28401-7404
US

IV. Provider business mailing address

1514 DOCTORS CIR
WILMINGTON NC
28401-7404
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-9914
  • Fax: 910-254-9953
Mailing address:
  • Phone: 910-254-9914
  • Fax: 910-254-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number34183
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: