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General NPI Number Information
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NPI Number | 1609533900
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Entity Type | Organization
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Legal Business Name | SANDS RECOVERY & WELLNESS LLC
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Dates
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Enumeration Date | 11/21/2021
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 1947 A1A S STE A
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-6509
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Country | US
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Telephone | 813-966-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 1947 A1A S STE A
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-6509
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Country | US
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Telephone | 813-966-9990
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Fax |
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Authorized Official
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Title or Position | AUTHORIZING MEMBER
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Name | MR. BRANDON SANDS
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Credential |
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Telephone | 813-966-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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