Provider Demographics
NPI:1265805386
Name:FREYMUTH, SANDRA LYNN (CSFA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:FREYMUTH
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:FREYMUTH
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSFA
Mailing Address - Street 1:6211 NW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1602
Mailing Address - Country:US
Mailing Address - Phone:954-369-8508
Mailing Address - Fax:
Practice Address - Street 1:6211 NW 34TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1602
Practice Address - Country:US
Practice Address - Phone:954-369-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant