=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700854031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CARE SPECIALISTS OF ORLANDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2006
-----------------------------------------------------
Last Update Date | 02/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7932 W SAND LAKE RD SUITE 200
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-355-7759
-----------------------------------------------------
Fax | 407-355-4987
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7932 W SAND LAKE RD SUITE 200
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-355-7759
-----------------------------------------------------
Fax | 407-355-4987
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MAHNAZ QAYYUM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-952-2320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------