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NPI Code Detail

MEDICARE: AMALI BAISSARI MD

MEDICARE: AMALI BAISSARI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1730886391
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMALI BAISSARI MD
Provider Business Mailing Address
First Line : 1122 ALTAMIRA ST NW
Second Line :
City : PALM BAY
State : FL
Zip : 32907-2737
Country : US
Telephone Number : 321-872-4650
Fax Number :
Provider Business Practice Location Address
First Line : 327 BEACH 19TH ST
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4423
Country : US
Telephone Number : 718-869-7672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 04/20/2026

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