Provider Demographics
NPI:1669496766
Name:BOXILL, SANDRA LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LINDA
Last Name:BOXILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:LINDA
Other - Last Name:BLACK-BOXILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 S. ANDREWS AVENUE
Mailing Address - Street 2:SUITE 323 WEST WING
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-355-5110
Mailing Address - Fax:954-355-4919
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:SUITE 323 WEST WING
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:954-355-4919
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-49040207V00000X
FLME93894207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274157100Medicaid
FLI47012Medicare UPIN
FL31008YMedicare PIN