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General NPI Number Information
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NPI Number | 1851920524
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Entity Type | Individual
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Provider Name | SAHENS MEZIDOR MD, PA
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Gender | Male
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 2880 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7935
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Country | US
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Telephone | 561-713-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 2880 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7935
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Country | US
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Telephone | 561-713-5015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HSE30491
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | NJDCATEMP-000594
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000295-PA
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License Number State | PR
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