1316013535 NPI number — DR. MUSADAG MAMOUN SINADA MD

Table of content: DR. MUSADAG MAMOUN SINADA MD (NPI 1316013535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316013535 NPI number — DR. MUSADAG MAMOUN SINADA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINADA
Provider First Name:
MUSADAG
Provider Middle Name:
MAMOUN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINADA
Provider Other First Name:
MUSADAG
Provider Other Middle Name:
MAMOUN MAHGOUB
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316013535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 NW 82ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-702-2100
Provider Business Mailing Address Fax Number:
480-878-7431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 NW 82ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-702-2100
Provider Business Practice Location Address Fax Number:
480-878-7431
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301086351 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME133245 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)