Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | ME133758 | FL |
Y | 2086S0127X | Trauma Surgeon | ME133758 | FL |
NPI | 1316262884 |
---|---|
Provider Name | Sandra Melissa Farach |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2010 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108652900 | (05) | FL |
3F5D3 | BCBS (01) | FL |