Provider Demographics
NPI:1659152528
Name:SIDDIQUI, MUHAMMAD AMIR ASAD
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AMIR ASAD
Last Name:SIDDIQUI
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 1:900 SAINT CHARLES PL APT 601
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3359
Mailing Address - Country:US
Mailing Address - Phone:347-387-7814
Mailing Address - Fax:
Practice Address - Street 1:900 SAINT CHARLES PL APT 601
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3359
Practice Address - Country:US
Practice Address - Phone:347-387-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health