Healthcare Provider Details

I. General information

NPI: 1336685155
Provider Name (Legal Business Name): SIMI SAHIBDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 W FAIRBANKS AVE STE 210
WINTER PARK FL
32789-4679
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7845
  • Fax: 407-646-7846
Mailing address:
  • Phone: 516-622-6000
  • Fax: 516-622-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010632
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: