MEDICARE: DR. WASEEM FATHALLA 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
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME150692	FL

General Provider Information

NPI Number	:	1942132519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WASEEM FATHALLA MD

Provider Business Mailing Address
First Line	:	3654 SWEET BUTTERCUP DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2957
Country	:	US
Telephone Number	:	386-289-9432
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 SWEET BUTTERCUP DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2957
Country	:	US
Telephone Number	:	386-289-9432
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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