Provider Demographics
NPI:1225419559
Name:ALY, TAREK (MD, MPH)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:
Last Name:ALY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BOOTH RD STE D
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5718
Mailing Address - Country:US
Mailing Address - Phone:407-906-3755
Mailing Address - Fax:
Practice Address - Street 1:208 BOOTH RD STE D
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5718
Practice Address - Country:US
Practice Address - Phone:407-906-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1401112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty