Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME57788 | FL |
NPI | 1033203633 |
---|---|
Provider Name | Dr. Sally Harris Sange |
First Address | Merritt Island, FL 32953-3444 |
Second Address | Merritt Island, FL 32953-3444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E58545 | (02) |