Healthcare Provider Details

I. General information

NPI: 1821783853
Provider Name (Legal Business Name): MENA AYMAN MESSIHA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 CORSAIR LN
MIDDLEBURG FL
32068-8555
US

IV. Provider business mailing address

8021 PHILIPS HWY STE 1
JACKSONVILLE FL
32256-7460
US

V. Phone/Fax

Practice location:
  • Phone: 904-323-0954
  • Fax:
Mailing address:
  • Phone: 904-323-0954
  • Fax: 904-660-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: