Provider Demographics
NPI:1619904695
Name:SOARES, SANDRA MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARY ANN
Last Name:SOARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 JAMES PAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-8047
Mailing Address - Country:US
Mailing Address - Phone:256-245-0297
Mailing Address - Fax:256-245-0624
Practice Address - Street 1:291 JAMES PAYTON BLVD
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-8047
Practice Address - Country:US
Practice Address - Phone:256-245-0297
Practice Address - Fax:256-245-0624
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics