Provider Demographics
NPI:1356500664
Name:CHEN-WALTA, SANDRA A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:CHEN-WALTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 10TH AVE
Mailing Address - Street 2:SUITE 405 (LOCATOR CODE R-23), DOMINION TOWER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1000
Mailing Address - Country:US
Mailing Address - Phone:305-243-3267
Mailing Address - Fax:305-243-2393
Practice Address - Street 1:1400 NW 10TH AVE
Practice Address - Street 2:SUITE 405 (LOCATOR CODE R-23), DOMINION TOWER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1000
Practice Address - Country:US
Practice Address - Phone:305-243-3267
Practice Address - Fax:305-243-2393
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1426602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily