# SANDRA WEAVER CLARK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245603075
- **Authorized official:** SANDRA WEAVER CLARK (CASE MANAGER)
- **Authorized official phone:** (321) 946-9866

## Contact information

- **Practice address:** 602 GEORGETOWN DR APT B, CASSELBERRY, FL 32707-6132
- **Practice address phone:** (321) 946-9866
- **Mailing address:** 602 GEORGETOWN DR APT B, CASSELBERRY, FL 32707-6132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/02/2015
- **Last updated:** 11/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009081000 | — | FL |