Provider Demographics
NPI:1104345594
Name:SARDANA, VANDIT (MSC, MD, FRCSC)
Entity type:Individual
Prefix:DR
First Name:VANDIT
Middle Name:
Last Name:SARDANA
Suffix:
Gender:M
Credentials:MSC, MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 RIBAUT ROAD
Mailing Address - Street 2:BMAC CREDENTIALING COORDINATOR
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-524-3015
Mailing Address - Fax:844-296-2306
Practice Address - Street 1:1680 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-524-3015
Practice Address - Fax:843-524-3020
Is Sole Proprietor?:No
Enumeration Date:2017-09-17
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291125207XS0114X
SC52519207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC52519OtherSTATE LICENSE BOARD
SC525195Medicaid