Healthcare Provider Details

I. General information

NPI: 1679493795
Provider Name (Legal Business Name): MERIDIAN CONCIERGE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 N PALM AVE
SARASOTA FL
34236-5604
US

IV. Provider business mailing address

468 QUAY CMNS UNIT 1104
SARASOTA FL
34236-1622
US

V. Phone/Fax

Practice location:
  • Phone: 941-445-0920
  • Fax: 941-248-0793
Mailing address:
  • Phone: 941-445-0920
  • Fax: 941-248-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOUSA ISSA ALYAN
Title or Position: OWNER
Credential: MA
Phone: 941-445-0920