Healthcare Provider Details

I. General information

NPI: 1730119702
Provider Name (Legal Business Name): HANEY N ASSAAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13067 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0926
US

IV. Provider business mailing address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 813-779-6303
  • Fax: 786-868-0012
Mailing address:
  • Phone: 321-841-3581
  • Fax: 321-841-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME76454
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301089242
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301089242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: