Healthcare Provider Details

I. General information

NPI: 1770047953
Provider Name (Legal Business Name): AMIRA AHMAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

IV. Provider business mailing address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: