Healthcare Provider Details

I. General information

NPI: 1902138282
Provider Name (Legal Business Name): SHARMEEN QUDROT-E-KHUDA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

6125 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1024
US

IV. Provider business mailing address

5989 AUGUSTA NATIONAL DR APT.202
ORLANDO FL
32822-3259
US

V. Phone/Fax

Practice location:
  • Phone: 407-442-8180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: