Provider Demographics
NPI:1548254204
Name:FEDAKO, CATHERINE A (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:A
Last Name:FEDAKO
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 1:2446 LAUREL RD E
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3204
Mailing Address - Country:US
Mailing Address - Phone:941-218-6200
Mailing Address - Fax:941-218-6182
Practice Address - Street 1:2446 LAUREL RD E
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3204
Practice Address - Country:US
Practice Address - Phone:941-218-6200
Practice Address - Fax:941-218-6182
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271354300Medicaid
FL11552WMedicare PIN
FL11552YMedicare PIN
FL271354300Medicaid