Healthcare Provider Details

I. General information

NPI: 1013992759
Provider Name (Legal Business Name): NICHOLO J. SARTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 LEE RD STE 165
WINTER PARK FL
32789
US

IV. Provider business mailing address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0410
  • Fax: 407-975-0413
Mailing address:
  • Phone: 407-975-0410
  • Fax: 407-975-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME113841
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9801478
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9801478
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME113841
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME113841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: