Provider Demographics
NPI:1972277333
Name:SANDRA DEE MD LLC
Entity Type:Organization
Organization Name:SANDRA DEE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-577-6888
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDRA DEE MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty