Provider Demographics
NPI:1841266764
Name:SANDS, BERNITA K (MD)
Entity type:Individual
Prefix:
First Name:BERNITA
Middle Name:K
Last Name:SANDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:7601 DR MARTIN LUTHER KING JR ST N STE E
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5200
Practice Address - Country:US
Practice Address - Phone:727-527-6719
Practice Address - Fax:727-527-5835
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251981000Medicaid
FL27837VMedicare PIN
G18699Medicare UPIN