Provider Demographics
NPI:1861489692
Name:LAWRENCE, SANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
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:PO BOX 970845
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33497-0845
Mailing Address - Country:US
Mailing Address - Phone:954-696-5623
Mailing Address - Fax:
Practice Address - Street 1:9960 CENTRAL PARK BLVD N STE 225
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1705
Practice Address - Country:US
Practice Address - Phone:954-696-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME610882080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255036900Medicaid