Healthcare Provider Details

I. General information

NPI: 1992324610
Provider Name (Legal Business Name): AYSHA SIDDIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 WESTON RD
WESTON FL
33331-3602
US

IV. Provider business mailing address

3100 WESTON RD
WESTON FL
33331-3602
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5670
  • Fax: 954-659-5358
Mailing address:
  • Phone: 954-659-5670
  • Fax: 954-659-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME168958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: