Provider Demographics
NPI:1538128228
Name:MORALES, SANDRA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:D
Last Name:MORALES
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 1:12780 WATERFORD LAKES PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4501
Mailing Address - Country:US
Mailing Address - Phone:407-380-5888
Mailing Address - Fax:407-384-1136
Practice Address - Street 1:12780 WATERFORD LAKES PKWY STE 135
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4501
Practice Address - Country:US
Practice Address - Phone:407-380-5888
Practice Address - Fax:407-384-1136
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378419300Medicaid
GA000673472AMedicaid
GA000673472AMedicaid
FL378419300Medicaid