Healthcare Provider Details

I. General information

NPI: 1811786528
Provider Name (Legal Business Name): SOUMAIA HAIDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 OLD OAK TREE DR
ORLANDO FL
32808-5992
US

IV. Provider business mailing address

5336 OLD OAK TREE DR
ORLANDO FL
32808-5992
US

V. Phone/Fax

Practice location:
  • Phone: 689-261-6778
  • Fax:
Mailing address:
  • Phone: 689-261-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: