Sand Lake Cancer Center, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9106328 Issued in FL

Legal business name

SAND LAKE CANCER CENTER, PA

Doing business as

Sand Lake Cancer Center Dispensary

Practice address

7301 Stonerock Cir Ste 2
Orlando, FL 32819-8004

Phone

(407) 351-1002

Fax

(407) 351-1119

NPI assigned

Sep 23, 2014

Last updated

Nov 11, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Asha Jiawan

Title

Practice Administrator

Phone

(407) 351-1002

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Sand Lake Cancer Center Dispensary Doing business as

Tax ID family

Sand Lake Cancer Center PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sand Lake Cancer Center, PA

  dba Sand Lake Cancer Center Dispensary

  • Specialist
  • Orlando, FL
  • NPI 1023485679
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael David Sombeck, M.D.

  • Radiation Oncology Physician
  • Lake Mary, FL
  • NPI 1184626129
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1609278597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 STONEROCK CIR",
            "address_2": "SUITE 2",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198004",
            "telephone_number": "407-351-1002",
            "fax_number": "407-351-1096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 STONEROCK CIR STE 2",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198004",
            "telephone_number": "407-351-1002",
            "fax_number": "407-351-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND LAKE CANCER CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2022-11-11",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "JIAWAN",
        "authorized_official_first_name": "ASHA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "407-351-1002",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME73340",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME76724",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME116521",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "K9074",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sand Lake Cancer Center Dispensary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Xiomara Sanchez, MHC
• Yuliana Makareth Sanchez
• Sanctuary Therapy & Wellness PLLC
• Sand Lake Cancer Center
• Sand Lake Cancer Center, PA (Sand Lake Cancer Center Dispensary)
• Sand Lake Dermatology Center, P.a.
• Sand Lake Health
• Sand Lake Imaging LLLP
• Sand Lake Internal Medicine, LLC
• Sand Lake Medical Associates, P.a.

• Medical Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.