Provider Demographics
NPI:1972342517
Name:RUSSI, SANDRA CAROLINA (MA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:CAROLINA
Last Name:RUSSI
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5113
Mailing Address - Country:US
Mailing Address - Phone:689-266-5601
Mailing Address - Fax:
Practice Address - Street 1:3463 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5113
Practice Address - Country:US
Practice Address - Phone:689-266-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health