Provider Demographics
NPI:1235200320
Name:SAHIN, MUSTAFA B (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:B
Last Name:SAHIN
Suffix:
Gender:M
Credentials:MD
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:321-574-9195
Mailing Address - Fax:
Practice Address - Street 1:1130 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-574-9195
Practice Address - Fax:321-952-6179
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159775207RH0000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041349OtherPREFERRED ONE
FLP6792OtherHF MA
FL116158800Medicaid
131480OtherUCARE
1041349OtherPREFERRED ONE
FL116158800Medicaid
FLP6792OtherHF MA
36-00013OtherMEDICA PRIMARY
SD7777470Medicaid
P00179403Medicare ID - Type UnspecifiedRAILROAD MEDICARE
36-00013OtherMEDICA PRIMARY
MN140155600Medicaid