MEDICARE: DR. SAHAR ABOUDAN 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	208000000X	Pediatrics Physician	ME63347	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	:	1528058575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAHAR ABOUDAN M.D

Provider Business Mailing Address
First Line	:	9905 SAINT AUGUSTINE RD
Second Line	:	STE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8982
Country	:	US
Telephone Number	:	904-260-3609
Fax Number	:	904-260-3610

Provider Business Practice Location Address
First Line	:	9905 ST AUGUSTINE RD
Second Line	:	STE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8983
Country	:	US
Telephone Number	:	190-426-0360
Fax Number	:	904-260-3610

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/14/2021

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