Provider Demographics
NPI:1881179828
Name:AYESHA AHMAR MD AND ASSOCIATES
Entity Type:Organization
Organization Name:AYESHA AHMAR MD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-333-3360
Mailing Address - Street 1:1349 S INTERNATIONAL PKWY STE 1411
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1698
Mailing Address - Country:US
Mailing Address - Phone:321-436-7089
Mailing Address - Fax:
Practice Address - Street 1:1349 S INTERNATIONAL PKWY STE 1411
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1698
Practice Address - Country:US
Practice Address - Phone:407-333-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262674800Medicaid