Provider Demographics
NPI:1417065277
Name:SACKELLARES, JAMES CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRIS
Last Name:SACKELLARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 SW 91ST TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7150
Mailing Address - Country:US
Mailing Address - Phone:352-375-5553
Mailing Address - Fax:352-505-5506
Practice Address - Street 1:5318 SW 91ST TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7150
Practice Address - Country:US
Practice Address - Phone:352-375-5553
Practice Address - Fax:352-505-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00726892084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB49103Medicare UPIN