Provider Demographics
NPI:1922278720
Name:NIEVES ROSADO, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:NIEVES ROSADO
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 1:366 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0926
Mailing Address - Country:US
Mailing Address - Phone:864-364-6380
Mailing Address - Fax:833-853-9422
Practice Address - Street 1:366 MARKET ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0926
Practice Address - Country:US
Practice Address - Phone:864-364-6380
Practice Address - Fax:833-853-9422
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247230207R00000X
SC85189207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCM048L064OtherMEDICARE