Provider Demographics
NPI:1225287576
Name:SOSA SEDA, IVETTE M (MD)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:M
Last Name:SOSA SEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVETTE
Other - Middle Name:M
Other - Last Name:SOSA-SEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:906 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4120
Mailing Address - Country:US
Mailing Address - Phone:904-541-0315
Mailing Address - Fax:904-541-0316
Practice Address - Street 1:906 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4120
Practice Address - Country:US
Practice Address - Phone:904-541-0315
Practice Address - Fax:904-541-0316
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133840207N00000X, 207N00000X
PR27178-R390200000X
MN55787207NI0002X
MN106296207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01105518OtherMEDICARE RAILROAD
MNP01105518OtherMEDICARE RAILROAD