Healthcare Provider Details

I. General information

NPI: 1740939842
Provider Name (Legal Business Name): FADY BISHAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MAGUIRE RD
OCOEE FL
34761-4752
US

IV. Provider business mailing address

11509 SOLAYA WAY UNIT 206
ORLANDO FL
32821-9445
US

V. Phone/Fax

Practice location:
  • Phone: 845-729-2344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: