Healthcare Provider Details

I. General information

NPI: 1710279591
Provider Name (Legal Business Name): SADIYA AHMED FAROOQUI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 N 56TH ST STE B
TEMPLE TERRACE FL
33617-5500
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 813-200-7717
  • Fax: 813-985-8500
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: