Healthcare Provider Details

I. General information

NPI: 1700518784
Provider Name (Legal Business Name): CHRISTINA ANN SARIDAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEMBROOK DR STE 300
ORLANDO FL
32810-6378
US

IV. Provider business mailing address

1120 ROUTE 73 STE 300
MOUNT LAUREL NJ
08054-5113
US

V. Phone/Fax

Practice location:
  • Phone: 800-442-8938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: