Healthcare Provider Details

I. General information

NPI: 1265675219
Provider Name (Legal Business Name): ASHFAQ KUDIA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 302A
SAINT AUGUSTINE FL
32080-3117
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 302A
SAINT AUGUSTINE FL
32080-3117
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-9330
  • Fax: 904-461-9331
Mailing address:
  • Phone: 904-461-9330
  • Fax: 904-461-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0068850
License Number StateFL

VIII. Authorized Official

Name: MRS. FURRIN KUDIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-461-9330