NPIMap

Organization Active NPI

Sandra Shrader, M.D. Dermatology LLC

  • Dermatology Physician
  • Melbourne, FL
National Provider Identifier
1962825208
Registry record updated Aug 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME78256 Issued in FL
Legal business name
SANDRA SHRADER, M.D. DERMATOLOGY LLC
Practice address
1700 W Hibiscus Blvd
Melbourne, FL 32901-2615
Phone
(321) 473-8989
Fax
(321) 802-4656
NPI assigned
Jan 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2014

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

Authorized official

Name
Dr. Sandra Shrader, M.D.
Title
Manager
Phone
(321) 473-8989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X ME78256 FL Primary

Addresses

Primary practice location

1700 W Hibiscus Blvd
Melbourne, FL 32901-2615

Mailing address

1700 W Hibiscus Blvd
Melbourne, FL 32901-2615
Phone (321) 473-8989

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1962825208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012615",
            "telephone_number": "321-473-8989",
            "fax_number": "321-802-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012615",
            "telephone_number": "321-473-8989",
            "fax_number": "321-802-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA SHRADER, M.D. DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "SHRADER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "321-473-8989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME78256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; 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.