Individual
SANDRA F DEFELICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10101 PARK ROWE AVE, SUITE 200, BATON ROUGE, LA 70810-1686
(225) 769-2200
(225) 768-2185
Mailing address
PO BOX 98509, BATON ROUGE, LA 70884-9509
(225) 769-2200
(225) 768-2185
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
A20094
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625850
—
LA
Enumeration date
10/20/2005
Last updated
03/28/2008
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