Healthcare Provider Details

I. General information

NPI: 1497045686
Provider Name (Legal Business Name): RUSHAD JUYIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 NIGHTWALKER RD
WEEKI WACHEE FL
34613-6349
US

IV. Provider business mailing address

7005 NIGHTWALKER RD
WEEKI WACHEE FL
34613-6349
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-2524
  • Fax: 352-556-5465
Mailing address:
  • Phone: 352-556-2524
  • Fax: 352-556-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberOS13277
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS13277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: