Healthcare Provider Details

I. General information

NPI: 1942370416
Provider Name (Legal Business Name): PEDIATRIC HOSPITAL SERVICES OF SOUTHWEST FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 DOCKSIDE CIR
WESTON FL
33327-1101
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-6345
  • Fax: 954-888-6967
Mailing address:
  • Phone: 954-457-8771
  • Fax: 954-241-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN S SAYFIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-457-8771