Healthcare Provider Details

I. General information

NPI: 1891724704
Provider Name (Legal Business Name): RANDELL JAY SEHRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 CYPRESS VILLAGE BLVD
SUN CITY CENTER FL
33573-6845
US

IV. Provider business mailing address

1046 CYPRESS VILLAGE BLVD
SUN CITY CENTER FL
33573-6845
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-0081
  • Fax: 813-633-0082
Mailing address:
  • Phone: 813-633-0081
  • Fax: 813-633-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME80519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: