Provider Demographics
NPI:1497133300
Name:SIDELSKY, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SIDELSKY
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:DEPARTMENT OF UROLOGY
Mailing Address - Street 2:BOX 100247
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0247
Mailing Address - Country:US
Mailing Address - Phone:352-273-6815
Mailing Address - Fax:
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 480
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2766
Practice Address - Country:US
Practice Address - Phone:386-317-3960
Practice Address - Fax:386-254-3131
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297546183500000X
IL125071763208600000X
FLME158626208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No183500000XPharmacy Service ProvidersPharmacist
No208600000XAllopathic & Osteopathic PhysiciansSurgery