Healthcare Provider Details

I. General information

NPI: 1457712010
Provider Name (Legal Business Name): SAHBA OBOUDIYAT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARKET STREET 8TH FLOOR
PHILADELPHIA PA
19104-5547
US

IV. Provider business mailing address

1800 LOMBARD ST
PHILADELPHIA PA
19146
US

V. Phone/Fax

Practice location:
  • Phone: 610-864-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS020533
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: