Healthcare Provider Details

I. General information

NPI: 1285398321
Provider Name (Legal Business Name): RAIYA HABIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAIYA HABIB MD

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD FL 32605
GAINESVILLE FL
32605-4392
US

IV. Provider business mailing address

3202 SW 1ST WAY
GAINESVILLE FL
32601-9083
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4000
  • Fax:
Mailing address:
  • Phone: 386-846-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: