Provider Demographics
NPI:1467701177
Name:SEDENU, IBHA (DNP/APRN/FNP/PMHNP)
Entity Type:Individual
Prefix:DR
First Name:IBHA
Middle Name:
Last Name:SEDENU
Suffix:
Gender:F
Credentials:DNP/APRN/FNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 MOSS PARK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5801
Mailing Address - Country:US
Mailing Address - Phone:951-468-6463
Mailing Address - Fax:920-696-8797
Practice Address - Street 1:331 N MAITLAND AVE STE C3
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4754
Practice Address - Country:US
Practice Address - Phone:407-214-5127
Practice Address - Fax:920-696-8797
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9281432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01125253OtherRAILROAD MEDICARE
FLGT286YMedicare UPIN
FLGT286XMedicare PIN