Healthcare Provider Details

I. General information

NPI: 1174098313
Provider Name (Legal Business Name): RACHEL SADY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLORIDA AVE STE 6
LAKELAND FL
33801-5237
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-0841
  • Fax: 863-616-9709
Mailing address:
  • Phone: 863-268-7850
  • Fax: 863-268-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: