Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN15762 | FL |
Y | 1223D0001X | Dental Public Health | DN15762 | FL |
NPI | 1306811187 |
---|---|
Provider Name | Dr. Sandra S Wasif |
First Address | Oviedo, FL 32765-6695 |
Second Address | Oviedo, FL 32765-6695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 26/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001347951 | NPI (01) | FL |
075214200 | (05) | FL |