Provider Demographics
NPI:1851662548
Name:SADRUNNISA HAMEEDI MD PA
Entity Type:Organization
Organization Name:SADRUNNISA HAMEEDI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SADRUNNISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-574-9034
Mailing Address - Street 1:809 DELTONA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7103
Mailing Address - Country:US
Mailing Address - Phone:386-574-9034
Mailing Address - Fax:386-574-9095
Practice Address - Street 1:809 DELTONA BLVD STE A
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7103
Practice Address - Country:US
Practice Address - Phone:386-574-9034
Practice Address - Fax:386-574-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME042306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052279100Medicaid
FL64510OtherMEDICARE
FL052279100Medicaid