Provider Demographics
NPI:1205853140
Name:SAHAR ABOUDAN PEDIATRICS,INC
Entity type:Organization
Organization Name:SAHAR ABOUDAN PEDIATRICS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-260-3609
Mailing Address - Street 1:9905 SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8982
Mailing Address - Country:US
Mailing Address - Phone:904-260-3609
Mailing Address - Fax:904-260-3610
Practice Address - Street 1:9905 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8982
Practice Address - Country:US
Practice Address - Phone:904-260-3609
Practice Address - Fax:904-260-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care