Provider Demographics
NPI:1285618512
Name:SUNDERMEYER, SARA BERYL (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:BERYL
Last Name:SUNDERMEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MAIN ST.
Mailing Address - Street 2:AUBURNDALE CHIROPRACTICE, LLC
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823
Mailing Address - Country:US
Mailing Address - Phone:863-968-0088
Mailing Address - Fax:863-968-0181
Practice Address - Street 1:214 MAIN ST.
Practice Address - Street 2:AUBURNDALE CHIROPRACTICE, LLC
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823
Practice Address - Country:US
Practice Address - Phone:863-968-0088
Practice Address - Fax:863-968-0181
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381673700Medicaid
P001650077OtherRR MEDICARE
FL381673700Medicaid
P001650077OtherRR MEDICARE