Provider Demographics
NPI:1053413443
Name:SANDY, DIANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:SANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:SANDY-CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2950 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:SUITE # A11/12
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3609
Mailing Address - Country:US
Mailing Address - Phone:954-659-5144
Mailing Address - Fax:954-659-6192
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:SUITE # A11/12
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-659-5144
Practice Address - Fax:954-659-6192
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070238207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307042Medicaid
OH2307042Medicaid
SA4070853Medicare ID - Type Unspecified