MEDICARE: ENDOCRINOLOGY & DIABETES SPECIALIST, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942065792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDOCRINOLOGY & DIABETES SPECIALIST, LLC

Provider Business Mailing Address
First Line	:	501 S KIRKMAN RD # 616587
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 PARK CENTER DR STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7621
Country	:	US
Telephone Number	:	703-862-4403
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SAIMA ALI
Credential	:
Telephone Number	:	703-862-4403

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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