Provider Demographics
NPI:1053428383
Name:MITJANS, SANDRA Y (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:Y
Last Name:MITJANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2843 SW 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5549
Mailing Address - Country:US
Mailing Address - Phone:305-769-5601
Mailing Address - Fax:305-769-0473
Practice Address - Street 1:4305 E 8TH AVE STE E
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-769-5601
Practice Address - Fax:305-769-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME407852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056822800Medicaid
FL056822800Medicaid