Provider Demographics
NPI:1033470844
Name:SEDLAK, TREVAN RANKIN (MD)
Entity Type:Individual
Prefix:
First Name:TREVAN
Middle Name:RANKIN
Last Name:SEDLAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 TROPICAL AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-3644
Mailing Address - Country:US
Mailing Address - Phone:828-320-5689
Mailing Address - Fax:
Practice Address - Street 1:KNOWLEDGE HEALTH 298 FIFTH AVENUE, FLOOR 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:516-210-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSP01DOtherFLORIDA BLUE
FL6056340OtherCIGNA
FL4701991OtherAETNA