Healthcare Provider Details

I. General information

NPI: 1942654546
Provider Name (Legal Business Name): DR. REBECCA MAE SIKAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DRIVE PO BOX 100412 ROOM D9-6
GAINESVILLE FL
32610
US

IV. Provider business mailing address

1505 FORT CLARKE BOULEVARD UNIT 1308
GAINESVILLE FL
32606
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5850
  • Fax:
Mailing address:
  • Phone: 847-571-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019024442
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: