MEDICARE: SANDI KAY CANDELLA P.A.

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	363A00000X	Physician Assistant	001002076	NC
2	363AS0400X	Surgical Physician Assistant	5274	GA
3	363AS0400X	Surgical Physician Assistant	3053	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568633824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDI KAY CANDELLA P.A.

Provider Business Mailing Address
First Line	:	10650 PARK RD
Second Line	:	SUITE 220
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-8538
Country	:	US
Telephone Number	:	704-667-3840
Fax Number	:	704-667-3899

Provider Business Practice Location Address
First Line	:	197 PIEDMONT BLVD STE 100
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1825
Country	:	US
Telephone Number	:	803-324-1950
Fax Number	:	803-324-1933

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	04/18/2024

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