Provider Demographics
NPI:1043302961
Name:WITT, SANDRA DESILVIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:DESILVIO
Last Name:WITT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 WINDING RIVER CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5419
Mailing Address - Country:US
Mailing Address - Phone:419-872-9413
Mailing Address - Fax:
Practice Address - Street 1:735 HASKINS RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1638
Practice Address - Country:US
Practice Address - Phone:419-352-8110
Practice Address - Fax:419-354-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2512-W213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795528Medicaid
OHBW2281006OtherDEA NUMBER
OHBW2281006OtherDEA NUMBER
OHU21751Medicare UPIN