Provider Demographics
NPI:1770526246
Name:SAKETKOO, DAVID FRANCIS (PSYD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANCIS
Last Name:SAKETKOO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9749 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2314
Mailing Address - Country:US
Mailing Address - Phone:954-452-6839
Mailing Address - Fax:954-563-5807
Practice Address - Street 1:1040 BAYVIEW DR
Practice Address - Street 2:SUITE 534
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2522
Practice Address - Country:US
Practice Address - Phone:954-993-7807
Practice Address - Fax:954-563-5807
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4009ZMedicare ID - Type UnspecifiedPROVIDER NUMBER