Provider Demographics
NPI:1427471663
Name:SANDERSON, JENNIFER S (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 EVERGREEN PL
Mailing Address - Street 2:APT. 301
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4353
Mailing Address - Country:US
Mailing Address - Phone:954-294-7428
Mailing Address - Fax:
Practice Address - Street 1:12955 BISCAYNE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2037
Practice Address - Country:US
Practice Address - Phone:954-465-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8878103TC0700X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities