Provider Demographics
NPI:1184513863
Name:ALY, FATIMAH
Entity type:Individual
Prefix:
First Name:FATIMAH
Middle Name:
Last Name:ALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13224 HEATHER MOSS DR APT 1212
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5545
Mailing Address - Country:US
Mailing Address - Phone:407-236-6834
Mailing Address - Fax:
Practice Address - Street 1:2951 PARK POND WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7661
Practice Address - Country:US
Practice Address - Phone:321-355-3904
Practice Address - Fax:407-201-4782
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-446688106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty