Healthcare Provider Details

I. General information

NPI: 1548041312
Provider Name (Legal Business Name): MEDOSH INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2573
US

IV. Provider business mailing address

789 DOUGLAS AVE STE 137
ALTAMONTE SPRINGS FL
32714-2573
US

V. Phone/Fax

Practice location:
  • Phone: 504-346-9660
  • Fax:
Mailing address:
  • Phone: 321-297-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ELVAN SARAC-JENNINGS
Title or Position: OWNER
Credential: L.AC, MD-TR
Phone: 504-346-9660