Provider Demographics
NPI:1649910605
Name:SANDERS-NIELSEN, SAVANNAH ASHLEE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ASHLEE
Last Name:SANDERS-NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6619 SKIPPER TER
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8330
Mailing Address - Country:US
Mailing Address - Phone:954-881-9823
Mailing Address - Fax:
Practice Address - Street 1:13650 NW 8TH ST STE 109
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6239
Practice Address - Country:US
Practice Address - Phone:888-864-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician