Provider Demographics
NPI:1164746962
Name:SANDIFER, LENA ANNE
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:ANNE
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7963
Mailing Address - Country:US
Mailing Address - Phone:843-314-1314
Mailing Address - Fax:843-314-1307
Practice Address - Street 1:64 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7963
Practice Address - Country:US
Practice Address - Phone:843-314-1314
Practice Address - Fax:843-314-1307
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36697207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics