MEDICARE: HUDA ALAEDDIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363AS0400X	Surgical Physician Assistant
3	363A00000X	Physician Assistant	PA9116820	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083139265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUDA ALAEDDIN PA-C

Provider Business Mailing Address
First Line	:	2253 GREEN HEDGES WAY STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6969
Country	:	US
Telephone Number	:	813-771-6851
Fax Number	:	813-771-6875

Provider Business Practice Location Address
First Line	:	2253 GREEN HEDGES WAY STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6969
Country	:	US
Telephone Number	:	813-771-6851
Fax Number	:	813-771-6875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	05/08/2023

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