Provider Demographics
NPI:1558712984
Name:SANDIFER, KENITH
Entity Type:Individual
Prefix:
First Name:KENITH
Middle Name:
Last Name:SANDIFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 VIA VERONA LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-6847
Mailing Address - Country:US
Mailing Address - Phone:407-907-2346
Mailing Address - Fax:
Practice Address - Street 1:520 VIA VERONA LN UNIT 101
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-6847
Practice Address - Country:US
Practice Address - Phone:407-907-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst