Healthcare Provider Details

I. General information

NPI: 1962949354
Provider Name (Legal Business Name): WAHEEDA SIDDIQUI AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

IV. Provider business mailing address

729 SUNRISE AVE STE 611
ROSEVILLE CA
95661-4548
US

V. Phone/Fax

Practice location:
  • Phone: 916-241-9844
  • Fax:
Mailing address:
  • Phone: 623-210-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9985
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number95008627
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: