MEDICARE: DAVID FRANCIS SAKETKOO PSY.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	103TC0700X	Clinical Psychologist	PY 7001	FL

General Provider Information

NPI Number	:	1770526246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID FRANCIS SAKETKOO PSY.D.

Provider Business Mailing Address
First Line	:	9749 SW 1ST ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2314
Country	:	US
Telephone Number	:	954-452-6839
Fax Number	:	954-563-5807

Provider Business Practice Location Address
First Line	:	1040 BAYVIEW DR
Second Line	:	SUITE 534
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-993-7807
Fax Number	:	954-563-5807

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/03/2010

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