Provider Demographics
NPI:1306179825
Name:MCKENZIE, SANDRA (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7662
Mailing Address - Country:US
Mailing Address - Phone:561-784-7852
Mailing Address - Fax:561-784-7851
Practice Address - Street 1:11905 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7662
Practice Address - Country:US
Practice Address - Phone:561-784-7852
Practice Address - Fax:561-784-7851
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9109566363A00000X
NY006748-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant