MEDICARE: SANDRA LYNN FREYMUTH CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1265805386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LYNN FREYMUTH CSFA

Provider Business Mailing Address
First Line	:	6211 NW 34TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1602
Country	:	US
Telephone Number	:	954-369-8508
Fax Number	:

Provider Business Practice Location Address
First Line	:	6211 NW 34TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1602
Country	:	US
Telephone Number	:	954-369-8508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	01/20/2026

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