Healthcare Provider Details

I. General information

NPI: 1376247726
Provider Name (Legal Business Name): FARYAL AHMED DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S FEDERAL HWY
FT LAUDERDALE FL
33316-2040
US

IV. Provider business mailing address

1309 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2040
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-4383
  • Fax: 954-463-8174
Mailing address:
  • Phone: 954-463-4383
  • Fax: 954-463-8174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: