Healthcare Provider Details

I. General information

NPI: 1255492096
Provider Name (Legal Business Name): SEBRING PEDIATRICS., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MEDICAL WAY SUITE 101
SEBRING FL
33870-5412
US

IV. Provider business mailing address

3201 MEDICAL WAY SUITE 101
SEBRING FL
33870-5412
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-0770
  • Fax: 863-471-9968
Mailing address:
  • Phone: 863-382-0770
  • Fax: 863-471-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN KRISHNADAS
Title or Position: MEDICAL DIRECTOR AND MANAGER
Credential: M.D.
Phone: 863-382-0770