Basic Information
| Provider Information | |||||||||
| NPI: | 1366886079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERLIN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10407 LARISSA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328218831 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 N SEMORAN BLVD | ||||||||
| Address2: | SUITE 195 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328073557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072822926 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN9195067 | FL | N | Nursing Service Providers | Registered Nurse | General Practice | 163WP0807X | RN9195067 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WP0808X | RN9195067 | FL | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | RN9195067 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.