Provider Demographics
NPI:1750040994
Name:SYDNOR CARDIOVASCULAR CENTER LLC
Entity Type:Organization
Organization Name:SYDNOR CARDIOVASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHIABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-553-2030
Mailing Address - Street 1:25941 US HIGHWAY 19 N UNIT 14808
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-7025
Mailing Address - Country:US
Mailing Address - Phone:813-553-2030
Mailing Address - Fax:413-431-4611
Practice Address - Street 1:25941 US HIGHWAY 19 N UNIT 14808
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33766-7025
Practice Address - Country:US
Practice Address - Phone:813-553-2030
Practice Address - Fax:413-431-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty