Provider Demographics
NPI:1407150030
Name:SPENCER, SANDRA DENISE
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DENISE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7405
Mailing Address - Country:US
Mailing Address - Phone:954-873-0501
Mailing Address - Fax:954-255-7097
Practice Address - Street 1:8819 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7405
Practice Address - Country:US
Practice Address - Phone:954-873-0501
Practice Address - Fax:954-255-7097
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator