Provider Demographics
NPI:1174398465
Name:MEDEROS RODRIGUEZ, SANDOR
Entity type:Individual
Prefix:
First Name:SANDOR
Middle Name:
Last Name:MEDEROS RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 ELAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917
Mailing Address - Country:US
Mailing Address - Phone:239-286-0712
Mailing Address - Fax:
Practice Address - Street 1:183 ELAND DR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917
Practice Address - Country:US
Practice Address - Phone:239-286-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician