Provider Demographics
NPI:1528123320
Name:SEDAROS, SOHAIR L (MD)
Entity type:Individual
Prefix:MRS
First Name:SOHAIR
Middle Name:L
Last Name:SEDAROS
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 1:25 E SILVER PALM AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3177
Mailing Address - Country:US
Mailing Address - Phone:321-725-3022
Mailing Address - Fax:321-952-8969
Practice Address - Street 1:25 E SILVER PALM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3177
Practice Address - Country:US
Practice Address - Phone:321-725-3022
Practice Address - Fax:321-952-8969
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85394Medicare UPIN
FL25025Medicare ID - Type Unspecified