Provider Demographics
NPI:1518068154
Name:TORRES, SANDRA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUSAN
Last Name:TORRES
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 1:1514 DOCTORS CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7404
Mailing Address - Country:US
Mailing Address - Phone:910-254-9914
Mailing Address - Fax:910-254-9953
Practice Address - Street 1:1514 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7404
Practice Address - Country:US
Practice Address - Phone:910-254-9914
Practice Address - Fax:910-254-9953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341832084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983631Medicaid
NC8983631Medicaid
NC8983631Medicaid