Provider Demographics
NPI:1285888099
Name:STEPHENIE SADICK, M.D., P.A.
Entity type:Organization
Organization Name:STEPHENIE SADICK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SADICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-415-1329
Mailing Address - Street 1:6355 NW 71ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1214
Mailing Address - Country:US
Mailing Address - Phone:954-415-1329
Mailing Address - Fax:954-972-7996
Practice Address - Street 1:7201 N. UNIVERSITY DR
Practice Address - Street 2:UNIVERSITY HOSIPITAL AND MEDICAL CENTER
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-415-1329
Practice Address - Fax:954-972-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273903800Medicaid
FLME64058OtherLIC#