Provider Demographics
NPI:1811007651
Name:GAYED, ESMAT ASHAM (MD)
Entity Type:Individual
Prefix:
First Name:ESMAT
Middle Name:ASHAM
Last Name:GAYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7005
Mailing Address - Country:US
Mailing Address - Phone:321-255-0959
Mailing Address - Fax:321-255-0225
Practice Address - Street 1:3021 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7005
Practice Address - Country:US
Practice Address - Phone:321-255-0959
Practice Address - Fax:321-255-0225
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250738200Medicaid
F91501Medicare UPIN
FL250738200Medicaid