MEDICARE: MRS. SANDRA SMITH HARMON 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	208000000X	Pediatrics Physician	ME 0038727	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61446	OTHER	FL	BS

General Provider Information

NPI Number	:	1700887049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA SMITH HARMON MD

Provider Business Mailing Address
First Line	:	5063 10TH AVE N
Second Line	:	PALM BEACH PEDIATRICS
City	:	GREENACRES
State	:	FL
Zip	:	33463-2048
Country	:	US
Telephone Number	:	561-683-7093
Fax Number	:	561-471-0887

Provider Business Practice Location Address
First Line	:	12955 PALMS WEST DR
Second Line	:	STE 100, BUILDING 8
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-4993
Country	:	US
Telephone Number	:	561-798-2468
Fax Number	:	561-798-2733

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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