Healthcare Provider Details

I. General information

NPI: 1003001884
Provider Name (Legal Business Name): LUCILLE T SAHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/04/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 MAHAN CENTER BLVD
TALLAHASSEE FL
32308-5428
US

IV. Provider business mailing address

4088 OLD PLANTATION LOOP
TALLAHASSEE FL
32311-1306
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-5310
  • Fax: 850-878-4483
Mailing address:
  • Phone: 810-691-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301061270
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME142052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: