Healthcare Provider Details

I. General information

NPI: 1447308564
Provider Name (Legal Business Name): RASHIDA B FASIUDDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-3221
US

IV. Provider business mailing address

1962 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-3221
US

V. Phone/Fax

Practice location:
  • Phone: 866-422-7367
  • Fax:
Mailing address:
  • Phone: 866-422-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: