Healthcare Provider Details

I. General information

NPI: 1083119028
Provider Name (Legal Business Name): MISHAH AZHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8315 RED BUG LAKE RD
OVIEDO FL
32765-6860
US

IV. Provider business mailing address

4541 S DALE MABRY HWY STE 100
TAMPA FL
33611-1407
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-6193
  • Fax: 407-599-6194
Mailing address:
  • Phone: 813-548-7860
  • Fax: 813-605-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: