Provider Demographics
NPI:1417075326
Name:ANETI, SANDRA E (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:ANETI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7646
Mailing Address - Country:US
Mailing Address - Phone:561-791-3452
Mailing Address - Fax:
Practice Address - Street 1:10115 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3105
Practice Address - Country:US
Practice Address - Phone:561-793-5515
Practice Address - Fax:561-793-4375
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02541Medicare ID - Type Unspecified