Provider Demographics
NPI:1831126051
Name:STEPHENS, SANDRA REBECCA (DO)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:REBECCA
Last Name:STEPHENS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97336 PIRATES POINT RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-1404
Mailing Address - Country:US
Mailing Address - Phone:904-200-2065
Mailing Address - Fax:
Practice Address - Street 1:22385 FLORA PARKE XING
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-8000
Practice Address - Country:US
Practice Address - Phone:904-404-8641
Practice Address - Fax:904-227-3246
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6988208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice