MEDICARE: THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME115520	FL

General Provider Information

NPI Number	:	1912366428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THYROID ENDOCRINOLOGY AND DIABETES SPECIALISTS OF TAMPA LLC

Provider Business Mailing Address
First Line	:	4030 HENDERSON BLVD STE 701
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-4940
Country	:	US
Telephone Number	:	813-474-3636
Fax Number	:	813-862-2536

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 360
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4192
Country	:	US
Telephone Number	:	813-474-3636
Fax Number	:	813-862-2536

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMBREEN QURESHI
Credential	:	M.D.
Telephone Number	:	813-474-3636

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	01/05/2026

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