Provider Demographics
NPI:1548577901
Name:BUI, SANDY LAU (DO)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:LAU
Last Name:BUI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 DON WICKHAM DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1977
Mailing Address - Country:US
Mailing Address - Phone:352-241-7275
Mailing Address - Fax:352-241-7281
Practice Address - Street 1:1920 DON WICKHAM DR STE 300
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1977
Practice Address - Country:US
Practice Address - Phone:352-241-7275
Practice Address - Fax:352-241-7281
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272975207V00000X
FLOS19860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03914101Medicaid