Provider Demographics
NPI:1811204761
Name:WONG, SANDRA C (AP, OMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:C
Last Name:WONG
Suffix:
Gender:F
Credentials:AP, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 W EAU GALLIE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8302
Mailing Address - Country:US
Mailing Address - Phone:321-752-0402
Mailing Address - Fax:
Practice Address - Street 1:2571 W EAU GALLIE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8302
Practice Address - Country:US
Practice Address - Phone:321-752-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist