Provider Demographics
NPI:1134578859
Name:DE JESUS MEDINA, SANDRA NAIRUBY (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NAIRUBY
Last Name:DE JESUS MEDINA
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:786-293-3200
Mailing Address - Fax:305-232-9082
Practice Address - Street 1:15077 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7930
Practice Address - Country:US
Practice Address - Phone:786-293-3200
Practice Address - Fax:305-232-9082
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124614200Medicaid
FL124614200Medicaid