Provider Demographics
NPI:1669684098
Name:VELLA, SANDRA PHILLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:PHILLIS
Last Name:VELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:# 300
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4107
Mailing Address - Fax:
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:# 300
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4107
Practice Address - Fax:786-497-2989
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 98768207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology