=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851451256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIO J CHEDIAK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 02/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 GLADES ROAD SUITE 220
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-750-9881
-----------------------------------------------------
Fax | 561-750-9644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 GLADES ROAD SUITE 220
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-6466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-750-9881
-----------------------------------------------------
Fax | 561-750-9644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | ME45193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | ME045193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME45193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------