Provider Demographics
NPI:1235139882
Name:SEDERHOLM, STEVEN D (AUD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:SEDERHOLM
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 S JOG RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1807
Mailing Address - Country:US
Mailing Address - Phone:561-734-5969
Mailing Address - Fax:561-734-3935
Practice Address - Street 1:11135 S JOG RD
Practice Address - Street 2:SUITE #2
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1807
Practice Address - Country:US
Practice Address - Phone:561-734-5969
Practice Address - Fax:561-734-3935
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY454231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS02552Medicare UPIN
FLS1019Medicare ID - Type Unspecified