Provider Demographics
NPI:1386350791
Name:FORONDA, SANDY L
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:L
Last Name:FORONDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 KINGS RAIL WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2491
Mailing Address - Country:US
Mailing Address - Phone:813-843-8646
Mailing Address - Fax:
Practice Address - Street 1:2200 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3416
Practice Address - Country:US
Practice Address - Phone:813-563-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist