MEDICARE: DR. KENNETH RAY SLADKIN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	ME57376	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447320049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RAY SLADKIN MD

Provider Business Mailing Address
First Line	:	8132 KING HELIE BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-1435
Country	:	US
Telephone Number	:	727-834-3959
Fax Number	:	727-816-1964

Provider Business Practice Location Address
First Line	:	192 VILLAGE DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7299
Country	:	US
Telephone Number	:	910-577-1400
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	02/08/2024

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