Organization
SAND LAKE CANCER CENTER, PA
Active
Organization
SAND LAKE CANCER CENTER, PA
Active
Other names
Sand Lake Cancer Center Dispensary
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ASHA JIAWAN (PRACTICE ADMINISTRATOR)
(407) 351-1002
Entity
Organization
Contact information
Practice address
7301 STONEROCK CIR STE 2, ORLANDO, FL 32819-8004
(407) 351-1002
(407) 351-1119
Mailing address
7301 STONEROCK CIR, SUITE 2, ORLANDO, FL 32819-8004
(407) 351-1002
(407) 351-1096
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME116521
FL
174400000X
Specialist
ME73340
FL
174400000X
Specialist
ME76724
FL
363AM0700X
Medical Physician Assistant
Primary
PA9106328
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K9074
PTAN
FL
Enumeration date
09/23/2014
Last updated
11/11/2022
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