Provider Demographics
NPI:1851650923
Name:SANDO, STEVEN C (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:SANDO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13188 N. 103RD DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-832-3444
Mailing Address - Fax:623-832-3470
Practice Address - Street 1:13188 N. 103RD DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-832-3444
Practice Address - Fax:623-832-3470
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103153187Medicaid