Provider Demographics
NPI:1578547154
Name:SANG, NELSON L (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:L
Last Name:SANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1982
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR STE 1B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-312-3325
Practice Address - Fax:321-409-1786
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME71582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250850800Medicaid
FL32234OtherBCBS
FL32234YOtherFL MEDICARE
FLP00292634OtherRR MEDICARE
FL250850800Medicaid