Provider Demographics
NPI:1750382057
Name:SANDRONI, STEPHEN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EUGENE
Last Name:SANDRONI
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 1:2911 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-5007
Mailing Address - Country:US
Mailing Address - Phone:850-644-1543
Mailing Address - Fax:
Practice Address - Street 1:2911 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-5007
Practice Address - Country:US
Practice Address - Phone:850-644-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44083207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115853700Medicaid
WV1809137000Medicaid
OH2258604Medicaid
OH2258604Medicaid
PA390007736Medicare PIN
PA050405NJ3Medicare PIN