Individual
SANDRA KAYE ARCHIBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
461 S NOVA RD, ORMOND BEACH, FL 32174
(386) 671-4337
(386) 671-1127
Mailing address
461 S NOVA RD, ORMOND BEACH, FL 32174-6138
(386) 671-4337
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
104271
FL
207P00000X
Emergency Medicine Physician
35509
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000057678
ANTHEM GROUP NUMBER
KY
01
—
029882600
FEDERAL BLACK LUNG GROUP
—
01
—
1131059
PASSPORT
KY
05
—
200301090A
—
IN
05
—
64025554
—
KY
01
—
930097462
RAILROAD MEDICARE
—
Enumeration date
01/09/2006
Last updated
02/13/2025
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