Provider Demographics
NPI:1730434028
Name:ETIENNE, SEDNEY (DOM AP)
Entity type:Individual
Prefix:
First Name:SEDNEY
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:DOM AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5263
Mailing Address - Country:US
Mailing Address - Phone:954-990-5431
Mailing Address - Fax:954-990-5437
Practice Address - Street 1:3845 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5263
Practice Address - Country:US
Practice Address - Phone:954-990-5431
Practice Address - Fax:954-990-5437
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3070171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist