Healthcare Provider Details

I. General information

NPI: 1184507386
Provider Name (Legal Business Name): SALEH A S A KH BUBISHATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL STE 401
KISSIMMEE FL
34747-4606
US

IV. Provider business mailing address

4950 LUNAR LN APT 414
KISSIMMEE FL
34746-1727
US

V. Phone/Fax

Practice location:
  • Phone: 321-559-9085
  • Fax:
Mailing address:
  • Phone: 321-559-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number43080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: