MEDICARE: OLGA SANFORD MD

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	2084P0800X	Psychiatry Physician	6914	KS
2	2084P0800X	Psychiatry Physician	0435265	KS
3	2084P0800X	Psychiatry Physician	ME 123463	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1K132Z	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1508031543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA SANFORD MD

Provider Business Mailing Address
First Line	:	3200 CITRUS TOWER BLVD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7012
Country	:	US
Telephone Number	:	352-536-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 CITRUS TOWER BLVD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-7012
Country	:	US
Telephone Number	:	352-536-8200
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	06/30/2022

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Directions to “ OLGA SANFORD MD” Practice Location

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