Healthcare Provider Details

I. General information

NPI: 1811359151
Provider Name (Legal Business Name): RAMSHA A. KUDIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 402B
ST AUGUSTINE FL
32080-3118
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 402B
ST AUGUSTINE FL
32080-3118
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-9420
  • Fax: 904-325-9420
Mailing address:
  • Phone: 904-325-9420
  • Fax: 904-558-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME142260
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME142260
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME142260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: