Healthcare Provider Details

I. General information

NPI: 1174488563
Provider Name (Legal Business Name): ASMA BASSAM AMAWI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 BEAR GULLY RD STE 1024
WINTER PARK FL
32792-9422
US

IV. Provider business mailing address

534 PINEBRANCH CIR
WINTER SPRINGS FL
32708-5634
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND4888
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAPRN11043388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: