Provider Demographics
NPI:1336212588
Name:SIFAIN, MAGGIE R (MD)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:R
Last Name:SIFAIN
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:P.O. BOX 5720
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5720
Mailing Address - Country:US
Mailing Address - Phone:904-697-5650
Mailing Address - Fax:407-650-7578
Practice Address - Street 1:1717 S. ORANGE AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229855208000000X
FLME1044272080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics