Provider Demographics
NPI:1356337596
Name:SAKHAEI, MASOUD (MD)
Entity type:Individual
Prefix:DR
First Name:MASOUD
Middle Name:
Last Name:SAKHAEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9164 SUGAR MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9620
Mailing Address - Country:US
Mailing Address - Phone:904-662-4460
Mailing Address - Fax:
Practice Address - Street 1:111 S MAGNOLIA DR
Practice Address - Street 2:SUITE 10-11
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2973
Practice Address - Country:US
Practice Address - Phone:850-878-5322
Practice Address - Fax:850-878-3120
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263972602Medicaid