Provider Demographics
NPI:1689833303
Name:MEDVEDOVSKY, BORIS (D O)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:MEDVEDOVSKY
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST STE 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2941
Mailing Address - Country:US
Mailing Address - Phone:941-917-8722
Mailing Address - Fax:
Practice Address - Street 1:1921 WALDEMERE ST STE 306
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2941
Practice Address - Country:US
Practice Address - Phone:941-917-8722
Practice Address - Fax:941-917-8727
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255628207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology