Provider Demographics
NPI:1063129740
Name:SARDINA, DAYRELIS MESA (PA)
Entity type:Individual
Prefix:
First Name:DAYRELIS
Middle Name:MESA
Last Name:SARDINA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1001
Mailing Address - Country:US
Mailing Address - Phone:321-331-3884
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4712
Practice Address - Country:US
Practice Address - Phone:954-436-8036
Practice Address - Fax:954-217-4006
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty