# IDA M SEBASTIAN MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558554063
- **Authorized official:** IDA SEBASTIAN MD (PRESIDENT)
- **Authorized official phone:** (561) 737-3174

## Contact information

- **Practice address:** 4526 SAINT ANDREWS DR, BOYNTON BEACH, FL 33436-4426
- **Practice address phone:** (561) 737-3174
- **Practice address fax:** (561) 737-3174
- **Mailing address:** 4526 SAINT ANDREWS DR, BOYNTON BEACH, FL 33436-4426
- **Mailing address phone:** (561) 737-3174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | ME28608 | FL | Yes |

## Other

- **Enumeration date:** 08/20/2007
- **Last updated:** 12/06/2007