Provider Demographics
NPI:1235202987
Name:SEBASTIAN CARDIOLGY PA
Entity Type:Organization
Organization Name:SEBASTIAN CARDIOLGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDINO
Authorized Official - Middle Name:G
Authorized Official - Last Name:CELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-9998
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:8005 BAY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3244
Practice Address - Country:US
Practice Address - Phone:772-589-9998
Practice Address - Fax:772-589-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37958ZOtherMEDICARE PTAN
FL269434400Medicaid
FL37958AMedicare ID - Type Unspecified
FLH84302Medicare UPIN
FL269434400Medicaid