Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY8870 | FL |
Y | 103G00000X | Clinical Psychologist | PY8870 | FL |
Y | 103TC0700X | Clinical Psychologist | PY8870 | FL |
NPI | 1366788606 |
---|---|
Provider Name | Dr. Kelley Christine Sanders |
First Address | Orlando, FL 32819-4200 |
Second Address | Orlando, FL 32819-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 23/09/2013 |