Healthcare Provider Details

I. General information

NPI: 1174430672
Provider Name (Legal Business Name): SADRA HAMEDZADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

7065 SIERRA CLUB CIR APT 1104
NAPLES FL
34113-7340
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-5000
  • Fax:
Mailing address:
  • Phone: 352-222-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: