Healthcare Provider Details

I. General information

NPI: 1457527608
Provider Name (Legal Business Name): SEDAROS & SEDAROS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E SILVER PALM AVE
MELBOURNE FL
32901
US

IV. Provider business mailing address

25 E SILVER PALM AVE
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-3022
  • Fax: 321-952-8969
Mailing address:
  • Phone: 321-725-3022
  • Fax: 321-952-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0023230
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0028265
License Number StateFL

VIII. Authorized Official

Name: DR. SOHAIR LABIB SEDAROS
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 321-725-3022