Healthcare Provider Details

I. General information

NPI: 1891409686
Provider Name (Legal Business Name): S D HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 301
DAVIE FL
33328-5310
US

IV. Provider business mailing address

5400 S UNIVERSITY DR STE 301
DAVIE FL
33328-5310
US

V. Phone/Fax

Practice location:
  • Phone: 954-636-2332
  • Fax: 240-219-3195
Mailing address:
  • Phone: 954-647-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA S DACCARETT
Title or Position: NP
Credential: DNP
Phone: 954-647-5609