Provider Demographics
NPI:1154427474
Name:HAMEEDI, SADRUNNISA S (MD)
Entity type:Individual
Prefix:MRS
First Name:SADRUNNISA
Middle Name:S
Last Name:HAMEEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5847
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32728-5847
Mailing Address - Country:US
Mailing Address - Phone:386-574-9034
Mailing Address - Fax:386-574-9095
Practice Address - Street 1:809 A DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-574-9034
Practice Address - Fax:386-574-9095
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010014135OtherRAILROAD MEDICARE
FL052279100Medicaid
64510OtherBLUE CROSS BL SH
010014135OtherRAILROAD MEDICARE
FL052279100Medicaid