Provider Demographics
NPI:1669449575
Name:SANDS, KENNETH C (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:SANDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13495
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4025
Mailing Address - Country:US
Mailing Address - Phone:321-725-2225
Mailing Address - Fax:321-308-0635
Practice Address - Street 1:709 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1938
Practice Address - Country:US
Practice Address - Phone:321-725-2225
Practice Address - Fax:321-308-0635
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055884207X00000X
FLME110558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA365707881AMedicaid
FL14F5ZOtherFLORIDA BLUE
FL003912700Medicaid
FL003912700Medicaid
FL14F5ZOtherFLORIDA BLUE
FLE8745YMedicare PIN