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General NPI Number Information
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NPI Number | 1265470108
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Entity Type | Organization
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Legal Business Name | DAVID SAKETKOO PSYD PA
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 1040 BAYVIEW DR SUITE 534
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2522
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Country | US
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Telephone | 954-993-7807
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Fax | 954-563-5807
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Provider Business Mailing Address
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Address Line | 9749 SW 1ST ST
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City | PLANTATION
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State | FL
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Zip | 33324-2314
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Country | US
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Telephone | 954-452-6839
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Fax | 954-563-5807
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID SAKETKOO
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Credential | PSY.D.
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Telephone | 954-993-7807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7001
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License Number State | FL
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