Provider Demographics
NPI:1922363191
Name:SANDERS, JAMAL R (MA)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 LEMON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4459
Mailing Address - Country:US
Mailing Address - Phone:813-850-9403
Mailing Address - Fax:
Practice Address - Street 1:5202 LEMON AVE APT B
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4459
Practice Address - Country:US
Practice Address - Phone:813-850-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health