Provider Demographics
NPI:1669876728
Name:SHAKED, SAGI
Entity type:Individual
Prefix:
First Name:SAGI
Middle Name:
Last Name:SHAKED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SE 1ST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7102
Mailing Address - Country:US
Mailing Address - Phone:954-773-9598
Mailing Address - Fax:954-773-9588
Practice Address - Street 1:150 SW 12TH AVE STE 101B
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-773-9598
Practice Address - Fax:954-773-9588
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)