Provider Demographics
NPI:1083358485
Name:HEDARY, ANTOINE S
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:S
Last Name:HEDARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-253-7553
Mailing Address - Fax:
Practice Address - Street 1:1220 N HIGHWAY A1A STE 147
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-2858
Practice Address - Country:US
Practice Address - Phone:321-253-7553
Practice Address - Fax:321-951-9127
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME175105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE HF