Provider Demographics
NPI:1548210008
Name:CAULFIELD, SANDRA (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CAULFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:239-656-6300
Mailing Address - Fax:239-656-6765
Practice Address - Street 1:3571 DEL PRADO BLVD N STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5287
Practice Address - Country:US
Practice Address - Phone:239-656-6300
Practice Address - Fax:239-656-6765
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3196363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0H8WOtherFLORIDA BLUE
FL970029584OtherRR MEDICARE
FL291202300Medicaid
FL291202300Medicaid