Provider Demographics
NPI:1740201748
Name:SEBRING PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:SEBRING PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-0770
Mailing Address - Street 1:1550 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7957
Mailing Address - Country:US
Mailing Address - Phone:863-382-0770
Mailing Address - Fax:863-471-9968
Practice Address - Street 1:1550 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7957
Practice Address - Country:US
Practice Address - Phone:863-382-0770
Practice Address - Fax:863-471-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103914Medicare ID - Type UnspecifiedMEDICARE RURAL HEALTH CLI
FL33877Medicare ID - Type UnspecifiedBC/BS