Provider Demographics
NPI:1285035097
Name:TABET, SAUNDRA MARIE (MS)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:MARIE
Last Name:TABET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:MARIE
Other - Last Name:GLAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2780 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2740
Mailing Address - Country:US
Mailing Address - Phone:305-646-0112
Mailing Address - Fax:
Practice Address - Street 1:2780 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2740
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076321700Medicaid