Basic Information
| Provider Information | |||||||||
| NPI: | 1720236730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBADI | ||||||||
| FirstName: | SEDIGHEH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9679 LAKE NONA VILLAGE PL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328277310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072612934 | ||||||||
| FaxNumber: | 4076367811 | ||||||||
| Practice Location | |||||||||
| Address1: | 9679 LAKE NONA VILLAGE PL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328277310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072612934 | ||||||||
| FaxNumber: | 4076367811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME102717 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | ME102717 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000445100 | 05 | FL | MEDICAID |