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General NPI Number Information
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NPI Number | 1962958264
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Entity Type | Organization
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Legal Business Name | QUALICARE PSYCHIATRY L.L.C.
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 42725 US-27 SUITE # 202
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City | DAVENPORT
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State | FL
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Zip | 33837
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Country | US
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Telephone | 520-907-6833
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Fax |
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Provider Business Mailing Address
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Address Line | 42725 HIGHWAY 27 SUITE 202
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City | DAVENPORT
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State | FL
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Zip | 33837-6821
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Country | US
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Telephone | 407-808-3808
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Fax |
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | FADY ASHAMALLA
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Credential | M.D.
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Telephone | 407-808-3808
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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 | ME117175
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License Number State | FL
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