Provider Demographics
NPI:1427061712
Name:CHEDIAK, NIDIA (MD)
Entity type:Individual
Prefix:DR
First Name:NIDIA
Middle Name:
Last Name:CHEDIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIDIA
Other - Middle Name:
Other - Last Name:CHEDIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1500 E HILLSBORO BLVD STE 107
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4356
Practice Address - Country:US
Practice Address - Phone:954-428-3500
Practice Address - Fax:954-428-1650
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63152Medicare UPIN
FL94197UMedicare ID - Type UnspecifiedMEDICARE NUMBER