Provider Demographics
NPI:1790423309
Name:DR. SANDRA V. MATTHEWS
Entity Type:Organization
Organization Name:DR. SANDRA V. MATTHEWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:VIRDA
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-378-7000
Mailing Address - Street 1:1393 ALLIGATOR DR
Mailing Address - Street 2:
Mailing Address - City:PANACEA
Mailing Address - State:FL
Mailing Address - Zip Code:32346-5113
Mailing Address - Country:US
Mailing Address - Phone:513-378-7000
Mailing Address - Fax:
Practice Address - Street 1:1393 ALLIGATOR DR
Practice Address - Street 2:
Practice Address - City:PANACEA
Practice Address - State:FL
Practice Address - Zip Code:32346-5113
Practice Address - Country:US
Practice Address - Phone:513-378-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM320798476670OtherDRIVER'S LICENSE