Basic Information
| Provider Information | |||||||||
| NPI: | 1306861711 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SAHAWNEH | ||||||||
| FirstName: | ALA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10051 5TH ST N STE 200 | ||||||||
| Address2: | JSA HEALTHCARE CORP | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337022211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136533111 | ||||||||
| FaxNumber: | 8136531384 | ||||||||
| Practice Location | |||||||||
| Address1: | 1933 W LUMSDEN RD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335118819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136533111 | ||||||||
| FaxNumber: | 8136531384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME93563 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 276792900 | 05 | FL | MEDICAID |