Healthcare Provider Details

I. General information

NPI: 1831419753
Provider Name (Legal Business Name): ANITA FATIMA HAFEEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD SUITE 200
ORLANDO FL
32822-8202
US

IV. Provider business mailing address

9113 PECKY CYPRESS WAY
ORLANDO FL
32836-6563
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6830
  • Fax: 407-303-6839
Mailing address:
  • Phone: 248-703-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: