Provider Demographics
NPI:1891352795
Name:SANDS, CALANDRA
Entity Type:Individual
Prefix:
First Name:CALANDRA
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S DIXIE HWY W STE 5
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8263
Mailing Address - Country:US
Mailing Address - Phone:954-708-0581
Mailing Address - Fax:
Practice Address - Street 1:801 S DIXIE HWY W STE 5
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8263
Practice Address - Country:US
Practice Address - Phone:954-708-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL02210091744P3200X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCL0221009OtherPROSTETIC SPECIALIST