=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144422767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SANDRA MCKENZIE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1852 N NOB HILL RD
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33322-6548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-476-6401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7610 NW 79TH AVE APT I5
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-9006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-770-6018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | MA19924
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------