Provider Demographics
NPI:1730101643
Name:SHAHEDA QAIYUMI, M.D. P.A.
Entity Type:Organization
Organization Name:SHAHEDA QAIYUMI, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:QAIYUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-2890
Mailing Address - Street 1:7109 NW 11TH PL STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3141
Mailing Address - Country:US
Mailing Address - Phone:352-331-2890
Mailing Address - Fax:352-331-2915
Practice Address - Street 1:7109 NW 11TH PL STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3141
Practice Address - Country:US
Practice Address - Phone:352-331-2890
Practice Address - Fax:352-331-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0042491207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94896OtherBCBS
FLK8669Medicare ID - Type Unspecified