Provider Demographics
NPI:1609564111
Name:BLANCO DE ANAYA SALLES, SANDOR (ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:SANDOR
Middle Name:
Last Name:BLANCO DE ANAYA SALLES
Suffix:
Gender:M
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7885 W 5TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4232
Mailing Address - Country:US
Mailing Address - Phone:786-286-0312
Mailing Address - Fax:
Practice Address - Street 1:7885 W 5TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4232
Practice Address - Country:US
Practice Address - Phone:786-286-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11220597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner