Provider Demographics
NPI:1477103117
Name:ENIOLA, SADE (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:SADE
Middle Name:
Last Name:ENIOLA
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARATHON LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5203
Mailing Address - Country:US
Mailing Address - Phone:321-222-0375
Mailing Address - Fax:
Practice Address - Street 1:201 MARATHON LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5203
Practice Address - Country:US
Practice Address - Phone:321-222-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist