Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A130695 | CA |
Y | 208000000X | Pediatrician | ME124323 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | D73945 | MD |
NPI | 1205079407 |
---|---|
Provider Name | Jane Park Sando |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 21/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056591100 | (05) | MD |