Healthcare Provider Details

I. General information

NPI: 1407072499
Provider Name (Legal Business Name): SANDEEP P DAVE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE SUITE 122
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE SUITE 122
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-3687
  • Fax: 305-662-8244
Mailing address:
  • Phone: 786-624-3687
  • Fax: 305-662-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME97525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: