MEDICARE: SANDRA MARYORY MONTOYA

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1821756362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARYORY MONTOYA

Provider Business Mailing Address
First Line	:	8534 SUN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7951
Country	:	US
Telephone Number	:	321-368-3551
Fax Number	:

Provider Business Practice Location Address
First Line	:	12701 S JOHN YOUNG PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-3420
Country	:	US
Telephone Number	:	407-203-1841
Fax Number	:

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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