Provider Demographics
NPI:1437406386
Name:AIDEYAN, UYI STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:UYI
Middle Name:STEPHEN
Last Name:AIDEYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:UYI
Other - Middle Name:STEPHEN
Other - Last Name:AIDEYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6900 NW 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3239
Mailing Address - Country:US
Mailing Address - Phone:786-323-7069
Mailing Address - Fax:
Practice Address - Street 1:11750 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3530
Practice Address - Country:US
Practice Address - Phone:305-223-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456775207R00000X
NY1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3351613OtherHIGHMARK BCBS
PA468051Medicare PIN