Provider Demographics
NPI:1174896112
Name:CLEOPHAT, SANDRAH (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRAH
Middle Name:
Last Name:CLEOPHAT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 PINES BLVD # 1369
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6609
Mailing Address - Country:US
Mailing Address - Phone:786-223-5211
Mailing Address - Fax:
Practice Address - Street 1:8403 PINES BLVD # 1369
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6609
Practice Address - Country:US
Practice Address - Phone:786-223-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL650267668282N00000X
FL9203445363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No282N00000XHospitalsGeneral Acute Care Hospital
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health