Provider Demographics
NPI:1114653318
Name:ABOUHAMMRA, MENA (MD)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:ABOUHAMMRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14809 ROYAL POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7330
Mailing Address - Country:US
Mailing Address - Phone:347-397-9051
Mailing Address - Fax:
Practice Address - Street 1:2500 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3709
Practice Address - Country:US
Practice Address - Phone:407-281-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL342592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry