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Organization
SOUTHEASTERN MEDICAL GROUP, INC
Active
Organization
SOUTHEASTERN MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA MILENA ZERVOUDAKIS LMHC (EXECUTIVE DIRECTOR)
(954) 398-1947
Entity
Organization
Contact information
Practice address
1881 NE 26TH ST, SUITE 224, WILTON MANORS, FL 33305-1416
(954) 398-1947
Mailing address
1881 NE 26TH ST, SUITE 224, WILTON MANORS, FL 33305-1416
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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