Provider Demographics
NPI:1407499544
Name:ALI, SHAHEED MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEED
Middle Name:MOHAMMED
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0645
Mailing Address - Country:US
Mailing Address - Phone:407-757-0277
Mailing Address - Fax:407-757-0271
Practice Address - Street 1:1550 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-757-0277
Practice Address - Fax:407-757-0271
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44380207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME44380OtherSTATE OF FLORIDA DOH DIVISON OF MEDICAL ASSURANCE