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General NPI Number Information
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NPI Number | 1265675219
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Entity Type | Organization
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Legal Business Name | ASHFAQ KUDIA, M.D., P.A.
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1301 PLANTATION ISLAND DR S STE 302A
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-3117
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Country | US
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Telephone | 904-461-9330
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Fax | 904-461-9331
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Provider Business Mailing Address
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Address Line | 1301 PLANTATION ISLAND DR S STE 302A
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-3117
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Country | US
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Telephone | 904-461-9330
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Fax | 904-461-9331
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. FURRIN KUDIA
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Credential |
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Telephone | 904-461-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0068850
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License Number State | FL
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