Healthcare Provider Details

I. General information

NPI: 1972647311
Provider Name (Legal Business Name): WAEL A JAMALEDDINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 CITRUS TOWER BLVD STE B
CLERMONT FL
34711-6889
US

IV. Provider business mailing address

33044 HWY 27
HAINES CITY FL
33844-7621
US

V. Phone/Fax

Practice location:
  • Phone: 352-900-5227
  • Fax: 352-308-3159
Mailing address:
  • Phone: 863-422-4977
  • Fax: 863-422-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME62749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: