Provider Demographics
NPI:1205079407
Name:SANDO, JANE PARK (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:PARK
Last Name:SANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:HEE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:ALL CHILDREN'S SPECIALTY PHYSICIANS
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-3051
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:ALL CHILDREN'S SPECIALTY PHYSICIANS
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-3051
Practice Address - Fax:727-767-4970
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD739452080P0204X
CAA130695208000000X
FLME124323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056591100Medicaid
MD056591100Medicaid