Provider Demographics
NPI:1306099304
Name:SARDINA, JUAN E (DPM)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:E
Last Name:SARDINA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BEACON CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3243
Mailing Address - Country:US
Mailing Address - Phone:561-845-6000
Mailing Address - Fax:561-845-6916
Practice Address - Street 1:4440 BEACON CIR STE 100
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3243
Practice Address - Country:US
Practice Address - Phone:561-845-6000
Practice Address - Fax:561-845-6916
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3468213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003442100Medicaid