Basic Information
| Provider Information | |||||||||
| NPI: | 1033470844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDLAK | ||||||||
| FirstName: | TREVAN | ||||||||
| MiddleName: | RANKIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 644 TROPICAL AVE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338973644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283205689 | ||||||||
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| Practice Location | |||||||||
| Address1: | KNOWLEDGE HEALTH 298 FIFTH AVENUE, FLOOR 7 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162106767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME122973 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | SP01D | 01 | FL | FLORIDA BLUE | OTHER | 6056340 | 01 | FL | CIGNA | OTHER | 4701991 | 01 | FL | AETNA | OTHER |