Provider Demographics
NPI:1407227556
Name:SANDI, MARIELA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:SANDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:350 NW 84TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1859
Practice Address - Country:US
Practice Address - Phone:954-474-2929
Practice Address - Fax:954-474-9708
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8YWJFOtherBCBS
FLP1035425OtherFREEDOM
FLP971160OtherOPTIMUM
FLP01584461OtherRR MEDICARE
FL4986247OtherAETNA
FL7811530OtherCIGNA
FLP01584458OtherRR MEDICARE
FLP01797372OtherSIMPLY
FL7811530OtherCIGNA
FLP1035425OtherFREEDOM