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5400 S University Dr Ste 301 Davie FL 33328-5310 | |
| (954) 636-2332 | |
| (240) 219-3195 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 5400 S University Dr Ste 301, Davie, Florida |
| Authorized Official Name and Position | Sandra S Daccarett (NP) |
| Authorized Official Contact | 9546475609 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5400 S University Dr Ste 301 Davie FL 33328-5310 Ph: (954) 647-5609 | 5400 S University Dr Ste 301 Davie FL 33328-5310 Ph: (954) 636-2332 |
| NPI Number | 1891409686 |
|---|---|
| Provider Enumeration Date | 01/06/2023 |
| Last Update Date | 11/15/2024 |
| Medicare PECOS PAC ID | 5991179483 |
|---|---|
| Medicare Enrollment ID | O20230323003306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891409686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Sandra Daccarett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093089245 PECOS PAC ID: 6406083161 Enrollment ID: I20131230001110 |
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