Provider Demographics
NPI:1295998672
Name:ELHUSEIN, SARA T (DO)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:ELHUSEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E HIBISCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3155
Mailing Address - Country:US
Mailing Address - Phone:321-724-2229
Mailing Address - Fax:
Practice Address - Street 1:330 E HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3155
Practice Address - Country:US
Practice Address - Phone:321-724-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16500207V00000X
NY280508207V00000X
MI5101017778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology