Healthcare Provider Details

I. General information

NPI: 1730101643
Provider Name (Legal Business Name): SHAHEDA QAIYUMI, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 NW 11TH PL STE A
GAINESVILLE FL
32605-3141
US

IV. Provider business mailing address

7109 NW 11TH PL STE A
GAINESVILLE FL
32605-3141
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2890
  • Fax: 352-331-2915
Mailing address:
  • Phone: 352-331-2890
  • Fax: 352-331-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME 0042491
License Number StateFL

VIII. Authorized Official

Name: DR. SHAHEDA QAIYUMI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-331-2890