Provider Demographics
NPI:1164484432
Name:PEDIATRIC CRITICAL CARE OF S FL PA
Entity Type:Organization
Organization Name:PEDIATRIC CRITICAL CARE OF S FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAYFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-454-5131
Mailing Address - Street 1:1117 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-457-8771
Mailing Address - Fax:954-241-6908
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:PICU
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-986-6345
Practice Address - Fax:954-888-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00655782080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty