Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME122219 | FL |
NPI | 1255692711 |
---|---|
Provider Name | Sareh S Dyer |
First Address | Maitland, FL 32751-5222 |
Second Address | Maitland, FL 32751-5222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 20/07/2015 |