Basic Information
| Provider Information | |||||||||
| NPI: | 1598256620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHELIMA | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3507 S MACDILL AVE | ||||||||
| Address2: | UNIT 9 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336291839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053160771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 807 S PARSONS AVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335116063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136738245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2018 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | DN23715 | FL | Y | Dental Providers | Dentist |
No ID Information.