Provider Demographics
NPI:1295023158
Name:MANN, SANDRA DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEBORAH
Last Name:MANN
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 1:3017 LANDMARK BLVD
Mailing Address - Street 2:#501
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-5006
Mailing Address - Country:US
Mailing Address - Phone:727-743-3766
Mailing Address - Fax:
Practice Address - Street 1:3017 LANDMARK BLVD
Practice Address - Street 2:#501
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-5006
Practice Address - Country:US
Practice Address - Phone:727-743-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine