Provider Demographics
NPI:1851484703
Name:SANCHEZ, SERVANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERVANDO
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16103 VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3328
Mailing Address - Country:US
Mailing Address - Phone:813-920-5717
Mailing Address - Fax:813-920-0171
Practice Address - Street 1:16103 VANDERBILT DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3328
Practice Address - Country:US
Practice Address - Phone:813-920-5717
Practice Address - Fax:813-920-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 37162208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54106Medicare UPIN