1154427474 NPI number — MRS. SADRUNNISA S HAMEEDI MD

Table of content: MRS. SADRUNNISA S HAMEEDI MD (NPI 1154427474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154427474 NPI number — MRS. SADRUNNISA S HAMEEDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMEEDI
Provider First Name:
SADRUNNISA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154427474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32728-5847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-574-9034
Provider Business Mailing Address Fax Number:
386-574-9095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 A DELTONA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-574-9034
Provider Business Practice Location Address Fax Number:
386-574-9095
Provider Enumeration Date:
09/15/2006

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:  ME0042306 , 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)

  • Identifier: 010014135 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 052279100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64510 . This is a "BLUE CROSS BL SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010494800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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