Healthcare Provider Details

I. General information

NPI: 1083574396
Provider Name (Legal Business Name): RASHA SIDDIQUI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 METROCENTER BLVD STE 100
ORLANDO FL
32835-7644
US

IV. Provider business mailing address

10933 CITRON OAKS DR
ORLANDO FL
32836-5036
US

V. Phone/Fax

Practice location:
  • Phone: 800-531-1587
  • Fax:
Mailing address:
  • Phone: 219-256-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9120728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: