Provider Demographics
NPI:1760801815
Name:AMELI, POUYA ALEXANDER (MD, MS)
Entity Type:Individual
Prefix:
First Name:POUYA
Middle Name:ALEXANDER
Last Name:AMELI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:POUYA
Other - Middle Name:
Other - Last Name:ABDOLLAHZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100236
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0236
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:
Practice Address - Street 1:UF NEUROLOGY MCKNIGHT BRAIN INSTITUTE 1149 NEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1452642084A2900X, 2084N0400X
GA0799282084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME145264OtherFLORIDA LICENSE
GA1760801815Medicaid
GA079928OtherGEORGIA LICENSE