Provider Demographics
NPI:1962474254
Name:DEE, SANDRA O (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:O
Last Name:DEE
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 1:947 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8361
Mailing Address - Country:US
Mailing Address - Phone:386-917-0075
Mailing Address - Fax:386-917-0655
Practice Address - Street 1:947 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8361
Practice Address - Country:US
Practice Address - Phone:386-917-0075
Practice Address - Fax:386-917-0655
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145892001Medicaid