Provider Demographics
NPI:1962075978
Name:JARAMILLO, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JARAMILLO
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 1:5600 COLLINS AVE APT 4W
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2403
Mailing Address - Country:US
Mailing Address - Phone:786-499-3682
Mailing Address - Fax:954-416-6171
Practice Address - Street 1:5600 COLLINS AVE APT 4W
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2403
Practice Address - Country:US
Practice Address - Phone:786-499-3682
Practice Address - Fax:954-416-6171
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689034296Medicaid