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General NPI Number Information
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NPI Number | 1912498130
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Entity Type | Individual
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Provider Name | AFFAN MOHIUDDIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 8132 LEE VISTA BLVD STE 102
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City | ORLANDO
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State | FL
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Zip | 32829-8367
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Country | US
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Telephone | 407-807-6522
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Fax | 407-988-1922
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Provider Business Mailing Address
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Address Line | 12830 WOODBURY GLEN DR
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City | ORLANDO
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State | FL
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Zip | 32828-5925
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Country | US
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Telephone | 407-923-1069
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4137
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9113282
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License Number State | FL
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