Provider Demographics
NPI:1205198611
Name:LUYINDULA, SANDRA E (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:LUYINDULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-455-9022
Mailing Address - Fax:864-455-9016
Practice Address - Street 1:103 FAIRVIEW POINTE DR
Practice Address - Street 2:FAIRVIEW FAMILY PRACTICE
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3223
Practice Address - Country:US
Practice Address - Phone:864-967-4982
Practice Address - Fax:864-967-8465
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA82768157Medicare PIN