Provider Demographics
NPI:1760639322
Name:SANDS, HARRY
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:SANDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 W 1ST ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3222
Mailing Address - Country:US
Mailing Address - Phone:239-332-8009
Mailing Address - Fax:239-332-4077
Practice Address - Street 1:2180 W 1ST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3222
Practice Address - Country:US
Practice Address - Phone:239-332-8009
Practice Address - Fax:239-332-4077
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
07161964OtherDATE OF BIRTH