Provider Demographics
NPI:1487894135
Name:HENRY, SANDRA MAUREEN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAUREEN
Last Name:HENRY
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 1:6945 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1550
Mailing Address - Country:US
Mailing Address - Phone:954-917-1125
Mailing Address - Fax:954-917-1126
Practice Address - Street 1:6945 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-1550
Practice Address - Country:US
Practice Address - Phone:954-917-1125
Practice Address - Fax:954-917-1126
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229452253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care