MEDICARE: SANA JAVED-EBEID M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME114243	FL

General Provider Information

NPI Number	:	1164790754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANA JAVED-EBEID M.D.

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:	904-450-6063
Fax Number	:	904-539-4091

Provider Business Practice Location Address
First Line	:	801 E 6TH ST STE 602
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3645
Country	:	US
Telephone Number	:	850-770-3030
Fax Number	:	850-770-3024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	07/16/2021

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