Provider Demographics
NPI:1639133507
Name:SARMIENTO, SANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:SARMIENTO
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:PO BOX 226106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33222-6106
Mailing Address - Country:US
Mailing Address - Phone:954-582-1200
Mailing Address - Fax:305-318-4261
Practice Address - Street 1:885 SW 109 AVE STE 131
Practice Address - Street 2:#113
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-3627
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253533500Medicaid
FL253533500Medicaid