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Organization
W SAND LAKE MEDICAL GROUP LLC
Active
Organization
W SAND LAKE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICK MATTEO (CFO)
(561) 318-4430
Entity
Organization
Contact information
Practice address
2431 SAND LAKE RD, ORLANDO, FL 32809-7641
(855) 876-8648
Mailing address
2328 10TH AVE N STE 302, LAKE WORTH, FL 33461-6612
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
12/22/2015
Last updated
12/22/2015
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