Provider Demographics
NPI:1396027991
Name:MEDINILLA, SANDRA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:P
Last Name:MEDINILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2374
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-623-7113
Mailing Address - Fax:302-623-7397
Practice Address - Street 1:4735 OGLETOWN STANTON ROAD
Practice Address - Street 2:MAP 2, SUITE 3301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-0000
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:302-623-4375
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC1-00100752086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program