Provider Demographics
NPI:1770676884
Name:LOPEZ, SANDRA B (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5807 NW ALLYSE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4650
Mailing Address - Country:US
Mailing Address - Phone:772-905-2583
Mailing Address - Fax:772-335-1116
Practice Address - Street 1:9850 S FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:772-335-1500
Practice Address - Fax:772-335-1116
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103461363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical