Provider Demographics
NPI:1609114230
Name:EGINTON, SANDRA ESMERALDA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ESMERALDA
Last Name:EGINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SW PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4356
Mailing Address - Country:US
Mailing Address - Phone:951-403-9183
Mailing Address - Fax:
Practice Address - Street 1:2005 SW PROVIDENCE PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4356
Practice Address - Country:US
Practice Address - Phone:951-403-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical