Provider Demographics
NPI:1104831072
Name:DABOVA-MISSOVA, SEVDALINA METODIEVA (MD)
Entity Type:Individual
Prefix:
First Name:SEVDALINA
Middle Name:METODIEVA
Last Name:DABOVA-MISSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:M
Other - Last Name:MISSOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-396-8971
Practice Address - Street 1:820 PRUDENTIAL DR STE 510
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8207
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8971
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46703207Q00000X
FLME137661207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN430034300Medicaid
I16112Medicare UPIN
MN080014275Medicare ID - Type Unspecified