Provider Demographics
NPI:1588611370
Name:KHALIDI, SAKINA (MD)
Entity Type:Individual
Prefix:
First Name:SAKINA
Middle Name:
Last Name:KHALIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5052
Mailing Address - Country:US
Mailing Address - Phone:941-629-3113
Mailing Address - Fax:941-629-9764
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-629-3113
Practice Address - Fax:941-629-9764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32809207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93657OtherBLUE CROSS BLUE SHIELD
FL93657AMedicare ID - Type UnspecifiedMEDICARE
FLD60535Medicare UPIN