Healthcare Provider Details

I. General information

NPI: 1205856705
Provider Name (Legal Business Name): AHMED QUAYE AIDOO MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 13TH ST
SAINT CLOUD FL
34769-4054
US

IV. Provider business mailing address

3501 13TH ST
SAINT CLOUD FL
34769-4054
US

V. Phone/Fax

Practice location:
  • Phone: 407-744-2610
  • Fax:
Mailing address:
  • Phone: 407-744-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36116409
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 96098
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME96098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: