Provider Demographics
NPI:1588094999
Name:BALDERSTON, SERA (DOM)
Entity type:Individual
Prefix:DR
First Name:SERA
Middle Name:
Last Name:BALDERSTON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SOUTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3126
Mailing Address - Country:US
Mailing Address - Phone:941-894-9847
Mailing Address - Fax:
Practice Address - Street 1:1720 SOUTHWOOD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3126
Practice Address - Country:US
Practice Address - Phone:941-894-9847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist