Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 3875 | FL |
Y | 213EP1101X | Primary Podiatric Medicine | PO3875 | FL |
NPI | 1114999158 |
---|---|
Provider Name | Dr. Stacey Sanders |
First Address | Fort Lauderdale, FL 33312-7107 |
Second Address | Fort Lauderdale, FL 33312-7107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76275 | (02) |