Provider Demographics
NPI:1528058575
Name:ABOUDAN, SAHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:ABOUDAN
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 1:9905 SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8982
Mailing Address - Country:US
Mailing Address - Phone:904-260-3609
Mailing Address - Fax:904-260-3610
Practice Address - Street 1:9905 ST AUGUSTINE RD
Practice Address - Street 2:STE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8983
Practice Address - Country:US
Practice Address - Phone:190-426-0360
Practice Address - Fax:904-260-3610
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375510000Medicaid
FL23139AMedicare PIN
FLF64118Medicare UPIN