MEDICARE: DR. EVELIO E SARDINA MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME117690	FL
2	207RP1001X	Pulmonary Disease Physician	ME117690	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14U8F	OTHER	FL	FLORIDA BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932171204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELIO E SARDINA MD PHD

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-0417
Country	:	US
Telephone Number	:	772-223-2832
Fax Number	:	772-223-5646

Provider Business Practice Location Address
First Line	:	3801 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-4801
Country	:	US
Telephone Number	:	772-223-4978
Fax Number	:	772-223-2847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	11/05/2020

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