Provider Demographics
NPI:1144260100
Name:GRANT, SANDRA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1775 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2620
Mailing Address - Country:US
Mailing Address - Phone:321-837-3820
Mailing Address - Fax:321-837-3654
Practice Address - Street 1:1775 W HIBISCUS BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2620
Practice Address - Country:US
Practice Address - Phone:321-837-3820
Practice Address - Fax:321-837-3654
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86879207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273546600Medicaid
I23787Medicare UPIN
FL273546600Medicaid