Individual
DR. SANDRA VIRDA MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1393 ALLIGATOR DR, PANACEA, FL 32346-5113
(513) 378-7000
Mailing address
1393 ALLIGATOR DR, PANACEA, FL 32346-5113
(513) 378-7000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
P5342
OH
103TC0700X
Clinical Psychologist
Primary
PY10575
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5342
FEE FOR SERVICE
OH
01
—
PY10575
FEE FOR SERVICE
FL
Enumeration date
01/03/2022
Last updated
01/03/2022
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