MEDICARE: MS. YUSRAH HAITHAM AL-DEEK PA-C

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
1	363A00000X	Physician Assistant	9109973	FL

General Provider Information

NPI Number	:	1740732627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YUSRAH HAITHAM AL-DEEK PA-C

Provider Business Mailing Address
First Line	:	508 SHERBURN CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-9015
Country	:	US
Telephone Number	:	407-982-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 ALAFAYA WOODS BLVD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6212
Country	:	US
Telephone Number	:	407-542-7335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	08/23/2021

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