Provider Demographics
NPI:1457527608
Name:SEDAROS & SEDAROS MD PA
Entity Type:Organization
Organization Name:SEDAROS & SEDAROS MD PA
Other - Org Name:SOHAIR L SEDAROS MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIR
Authorized Official - Middle Name:LABIB
Authorized Official - Last Name:SEDAROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-725-3022
Mailing Address - Street 1:25 E SILVER PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-725-3022
Mailing Address - Fax:321-952-8969
Practice Address - Street 1:25 E SILVER PALM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-725-3022
Practice Address - Fax:321-952-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028265207Q00000X
FLME0023230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057027300Medicaid
FLD85394Medicare UPIN
FL057027300Medicaid