Provider Demographics
NPI:1003890674
Name:SEQUEIRA, EDUARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:J
Last Name:SEQUEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SATINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1601
Mailing Address - Country:US
Mailing Address - Phone:561-889-7927
Mailing Address - Fax:772-882-4931
Practice Address - Street 1:79 SATINWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1601
Practice Address - Country:US
Practice Address - Phone:561-889-7927
Practice Address - Fax:772-882-4931
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8024006Medicaid
FL8024006Medicaid
49520Medicare ID - Type Unspecified