Provider Demographics
NPI:1285692293
Name:FANDINO-SENDE, FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:FANDINO-SENDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:954-424-0765
Practice Address - Street 1:350 NW 84TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1847
Practice Address - Country:US
Practice Address - Phone:954-424-4321
Practice Address - Fax:954-424-0765
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51899207RC0000X
LAMD.206976207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019493500Medicaid
FL10901OtherBCBS OF FL
FL375403100Medicaid
FL10901ZMedicare PIN