Provider Demographics
NPI:1770861734
Name:DRAPER, SANDRA D (LMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:DRAPER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9790 66TH ST N
Mailing Address - Street 2:# 135
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2803
Mailing Address - Country:US
Mailing Address - Phone:727-548-4143
Mailing Address - Fax:
Practice Address - Street 1:9790 66TH ST N
Practice Address - Street 2:# 135
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2803
Practice Address - Country:US
Practice Address - Phone:727-548-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 25006171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor