Healthcare Provider Details

I. General information

NPI: 1154881720
Provider Name (Legal Business Name): MAYYADAH AL-NUAIMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 N SHADELAND AVE STE A
INDIANAPOLIS IN
46219-1706
US

IV. Provider business mailing address

4770 REGENT BLVD
IRVING TX
75063-2445
US

V. Phone/Fax

Practice location:
  • Phone: 800-890-6220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01099227A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: