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General NPI Number Information
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NPI Number | 1730361262
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Entity Type | Individual
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Provider Name | SANDRA VIDAL M.S.
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 4425 PARK BLVD
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3540
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Country | US
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Telephone | 727-235-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 12001 DR MARTIN LUTHER KING JR ST N APT 2611
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City | ST PETERSBURG
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State | FL
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Zip | 33716-1618
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Country | US
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Telephone | 941-284-1821
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH6318
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License Number State | FL
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