Provider Demographics
NPI:1467642371
Name:KHODADADEH, SARAH (MD, MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KHODADADEH
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 37TH PL STE 101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6579
Mailing Address - Country:US
Mailing Address - Phone:772-758-1000
Mailing Address - Fax:772-758-2000
Practice Address - Street 1:1000 37TH PL STE 101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6579
Practice Address - Country:US
Practice Address - Phone:772-758-1000
Practice Address - Fax:772-758-2000
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119283174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist