Healthcare Provider Details

I. General information

NPI: 1245328293
Provider Name (Legal Business Name): PEDIATRIC HOSPITALIST OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

V. Phone/Fax

Practice location:
  • Phone: 954-457-8771
  • Fax: 954-241-6908
Mailing address:
  • Phone: 954-457-8771
  • Fax: 954-241-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065578
License Number StateFL

VIII. Authorized Official

Name: MR. JORDAN S SAYFIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-454-5131