=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982668604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEEPTI H SADHWANI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 02/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12920 US HIGHWAY 1
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-581-2373
-----------------------------------------------------
Fax | 772-581-2374
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12920 US HIGHWAY 1
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-581-2373
-----------------------------------------------------
Fax | 772-581-2374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME76140
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------