Provider Demographics
NPI:1760789242
Name:SESAME FLYERS OF SOUTH FLORIDA INC.
Entity Type:Organization
Organization Name:SESAME FLYERS OF SOUTH FLORIDA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:HENDERSON
Authorized Official - Last Name:ANSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-274-7233
Mailing Address - Street 1:6781 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4073
Mailing Address - Country:US
Mailing Address - Phone:954-274-7233
Mailing Address - Fax:954-741-6902
Practice Address - Street 1:6781 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4073
Practice Address - Country:US
Practice Address - Phone:954-274-7233
Practice Address - Fax:954-741-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization