Provider Demographics
NPI:1851451256
Name:CHEDIAK, NATALIO J (MD)
Entity Type:Individual
Prefix:
First Name:NATALIO
Middle Name:J
Last Name:CHEDIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 GLADES ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6466
Mailing Address - Country:US
Mailing Address - Phone:561-750-9881
Mailing Address - Fax:561-750-9644
Practice Address - Street 1:660 GLADES ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6466
Practice Address - Country:US
Practice Address - Phone:561-750-9881
Practice Address - Fax:561-750-9644
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME451932084S0012X, 2084N0400X
FLME0451932084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1851451256OtherNPI
FL94537OtherBLUE CROSS BLUE SHIELD
FL1053506790OtherNPI GROUP
FLD63262Medicare UPIN