Provider Demographics
NPI:1073881462
Name:SOUTH FLORIDA BREAST SPECIALISTS PLLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA BREAST SPECIALISTS PLLC
Other - Org Name:DENISE SANDERSON MD PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE ORTEGA
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-848-7426
Mailing Address - Street 1:401 SE OSCEOLA ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2220 SE OCEAN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-872-6913
Practice Address - Fax:772-872-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty