Provider Demographics
NPI:1801223458
Name:VALDEBENITO, SANDRA V (LMT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:V
Last Name:VALDEBENITO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 MOCCASIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5646
Mailing Address - Country:US
Mailing Address - Phone:407-923-7398
Mailing Address - Fax:
Practice Address - Street 1:1018 MOCCASIN RUN RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5646
Practice Address - Country:US
Practice Address - Phone:407-923-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA21156171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor