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General NPI Number Information
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NPI Number | 1023693629
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Entity Type | Individual
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Provider Name | SANDY CILLIAC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 501 S KIRKMAN RD UNIT 616145
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City | ORLANDO
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State | FL
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Zip | 32861-2508
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Country | US
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Telephone | 904-525-7149
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 616145
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City | ORLANDO
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State | FL
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Zip | 32861-6145
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Country | US
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Telephone | 904-525-7149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | FL
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