Provider Demographics
NPI:1720150600
Name:VAUSE, SANDRA EVE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:EVE
Last Name:VAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W REDBANK
Mailing Address - Street 2:
Mailing Address - City:W. DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3407
Mailing Address - Country:US
Mailing Address - Phone:856-241-3311
Mailing Address - Fax:856-241-3969
Practice Address - Street 1:100 W REDBANK
Practice Address - Street 2:SETO MEDICAL PROVIDERS
Practice Address - City:W. DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3407
Practice Address - Country:US
Practice Address - Phone:856-241-3311
Practice Address - Fax:856-241-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129987207N00000X
NJMA059140207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070010774OtherRAILROAD MEDICARE
NJ5653606Medicaid
NJ0456393OtherAETNA
FL019587900Medicaid
NJ616834OtherHORIZON BC BS OF NJ
NJ616834OtherHORIZON BC BS OF NJ
NJF05283Medicare UPIN
FL019587900Medicaid
NJ0456393OtherAETNA