Provider Demographics
NPI:1144584202
Name:MAHNAZ QAYYUM MEDICAL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MAHNAZ QAYYUM MEDICAL ENTERPRISES, LLC
Other - Org Name:FAMILY PRACTICE OF CELEBRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:QAYYUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-355-7759
Mailing Address - Street 1:7932 W SAND LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7299
Mailing Address - Country:US
Mailing Address - Phone:407-355-7759
Mailing Address - Fax:407-355-4987
Practice Address - Street 1:7932 W SAND LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7299
Practice Address - Country:US
Practice Address - Phone:407-355-7759
Practice Address - Fax:407-355-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty