Provider Demographics
NPI:1548562713
Name:SAATIAH JAFFRY, MD LLC
Entity Type:Organization
Organization Name:SAATIAH JAFFRY, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAATIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-643-4371
Mailing Address - Street 1:PO BOX 781737
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32978-1737
Mailing Address - Country:US
Mailing Address - Phone:772-918-8487
Mailing Address - Fax:772-918-8621
Practice Address - Street 1:7965 BAY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3282
Practice Address - Country:US
Practice Address - Phone:772-918-8487
Practice Address - Fax:772-918-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107571207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEC126AMedicare PIN