Healthcare Provider Details

I. General information

NPI: 1285157040
Provider Name (Legal Business Name): BASSEM ADEL ELSEIFY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15912 E.STATE RD. 40
SILVER SPRINGS FL
34488
US

IV. Provider business mailing address

15912 E.STATE RD. 40
SILVER SPRINGS FL
34488
US

V. Phone/Fax

Practice location:
  • Phone: 352-625-2866
  • Fax: 352-625-2330
Mailing address:
  • Phone: 352-625-2866
  • Fax: 352-625-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS54489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: