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General NPI Number Information
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NPI Number | 1134578859
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Entity Type | Individual
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Provider Name | SANDRA NAIRUBY DE JESUS MEDINA MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 15077 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33176-7930
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Country | US
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Telephone | 786-293-3200
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Fax | 305-232-9082
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Provider Business Mailing Address
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Address Line | 900 S PINE ISLAND RD STE 800
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City | PLANTATION
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State | FL
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Zip | 33324-3923
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Country | US
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Telephone | 786-293-3200
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Fax | 305-232-9082
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME138843
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License Number State | FL
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