Healthcare Provider Details

I. General information

NPI: 1891416962
Provider Name (Legal Business Name): BASHAER ALDHAHWANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1134
US

IV. Provider business mailing address

501 NE 31ST ST UNIT 605
MIAMI FL
33137-4480
US

V. Phone/Fax

Practice location:
  • Phone: 305-339-0402
  • Fax:
Mailing address:
  • Phone: 305-339-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number36475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: