Provider Demographics
NPI:1548890015
Name:SARKISIAN, REECE TODD
Entity type:Individual
Prefix:
First Name:REECE
Middle Name:TODD
Last Name:SARKISIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 JESSAMINE CT
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-3424
Mailing Address - Country:US
Mailing Address - Phone:386-960-4455
Mailing Address - Fax:
Practice Address - Street 1:2014 JESSAMINE CT
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-3424
Practice Address - Country:US
Practice Address - Phone:386-960-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)