Provider Demographics
NPI:1760435986
Name:MONTIE, SANDRA E (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:MONTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:COADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2500
Mailing Address - Country:US
Mailing Address - Phone:772-219-2777
Mailing Address - Fax:772-219-0017
Practice Address - Street 1:440 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2500
Practice Address - Country:US
Practice Address - Phone:772-219-2777
Practice Address - Fax:772-219-0017
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001616OtherSTATE LICENSE
Q28930Medicare UPIN
IAI14121Medicare ID - Type Unspecified