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General NPI Number Information
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NPI Number | 1386827590
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Entity Type | Individual
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Provider Name | MAHA LAHOUD-BLADYKAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BLVD
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City | BAY PINES
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State | FL
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Zip | 33744-8200
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 7353 HUNT CLUB LN
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City | SEMINOLE
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State | FL
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Zip | 33776-4228
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Country | US
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Telephone | 727-643-9697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0116014447
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME122904
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License Number State | FL
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