Provider Demographics
NPI:1568046415
Name:MAHMOUD, MEKAAEL
Entity Type:Individual
Prefix:
First Name:MEKAAEL
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21208 WAYMOUTH RUN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3243
Mailing Address - Country:US
Mailing Address - Phone:401-256-9997
Mailing Address - Fax:
Practice Address - Street 1:21208 WAYMOUTH RUN
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3243
Practice Address - Country:US
Practice Address - Phone:401-256-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23114225X00000X
RIOTA01100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant