Provider Demographics
NPI:1457364234
Name:SANDA, ANIKA L (MD)
Entity type:Individual
Prefix:DR
First Name:ANIKA
Middle Name:L
Last Name:SANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 HAMILTON LNDG
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-8256
Mailing Address - Country:US
Mailing Address - Phone:415-884-1876
Mailing Address - Fax:
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:415-383-3500
Practice Address - Fax:415-383-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A707420Medicaid
CAH86083Medicare UPIN