Provider Demographics
NPI:1841885233
Name:SDA DIALYSIS CENTER LLC
Entity type:Organization
Organization Name:SDA DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-803-9091
Mailing Address - Street 1:PO BOX 7496
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33338-7496
Mailing Address - Country:US
Mailing Address - Phone:917-803-9091
Mailing Address - Fax:954-208-4533
Practice Address - Street 1:3911 HOLLYWOOD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6795
Practice Address - Country:US
Practice Address - Phone:954-880-5553
Practice Address - Fax:954-208-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty