Provider Demographics
NPI:1851920524
Name:MEZIDOR, SAHENS (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:SAHENS
Middle Name:
Last Name:MEZIDOR
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7935
Mailing Address - Country:US
Mailing Address - Phone:561-713-5015
Mailing Address - Fax:
Practice Address - Street 1:2880 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7935
Practice Address - Country:US
Practice Address - Phone:561-713-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE30491208D00000X
NJNJDCATEMP-000594363A00000X
PR000295-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice