Provider Demographics
NPI:1770662033
Name:SANDRA K. FAUST, PH.D. P.A.
Entity Type:Organization
Organization Name:SANDRA K. FAUST, PH.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-463-4190
Mailing Address - Street 1:508 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2322
Mailing Address - Country:US
Mailing Address - Phone:772-463-4190
Mailing Address - Fax:772-223-6313
Practice Address - Street 1:508 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2322
Practice Address - Country:US
Practice Address - Phone:772-463-4190
Practice Address - Fax:772-223-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 1474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty