Provider Demographics
NPI:1508021411
Name:FERDOWSI, SAHBA (DO)
Entity Type:Individual
Prefix:DR
First Name:SAHBA
Middle Name:
Last Name:FERDOWSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:SAHBA
Other - Middle Name:
Other - Last Name:FERDOWSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, PA
Mailing Address - Street 1:2344 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3249
Mailing Address - Country:US
Mailing Address - Phone:305-778-0273
Mailing Address - Fax:305-649-4576
Practice Address - Street 1:2344 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3249
Practice Address - Country:US
Practice Address - Phone:305-778-0273
Practice Address - Fax:305-649-4576
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10297207QS0010X, 207Q00000X, 207QA0505X, 207QG0300X, 207PE0004X, 2083S0010X, 207QA0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260832046OtherTAX ID
FL1245413194OtherGROUP NPI
FL1245413194OtherGROUP NPI
FL260832046OtherTAX ID