Provider Demographics
NPI:1891881694
Name:SANDERS, DIANE L (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:260 SW 84TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2715
Mailing Address - Country:US
Mailing Address - Phone:954-327-3337
Mailing Address - Fax:954-327-7177
Practice Address - Street 1:260 SW 84TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2715
Practice Address - Country:US
Practice Address - Phone:954-327-3337
Practice Address - Fax:954-327-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN