Healthcare Provider Details

I. General information

NPI: 1851920524
Provider Name (Legal Business Name): SAHENS MEZIDOR MD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 S SEACREST BLVD
BOYNTON BEACH FL
33435-7935
US

IV. Provider business mailing address

2880 S SEACREST BLVD
BOYNTON BEACH FL
33435-7935
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-5015
  • Fax:
Mailing address:
  • Phone: 561-713-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHSE30491
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberNJDCATEMP-000594
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000295-PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: