Healthcare Provider Details

I. General information

NPI: 1790282168
Provider Name (Legal Business Name): SARDION JIJELAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 NE 28TH AVE STE 205
AVENTURA FL
33180-1402
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-5993
  • Fax: 305-933-9415
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number324516
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA193435
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME79898
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number79898
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: