Provider Demographics
NPI:1457606923
Name:SARDO, MARTHA A (MEDU)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:SARDO
Suffix:
Gender:F
Credentials:MEDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1480
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:
Practice Address - Street 1:1485 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1480
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:321-397-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NO LICENSE NUMBER171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL171M00000XOther17