Provider Demographics
NPI:1972930717
Name:SALIA, QAZIM
Entity Type:Individual
Prefix:
First Name:QAZIM
Middle Name:
Last Name:SALIA
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 1:600 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3489
Mailing Address - Country:US
Mailing Address - Phone:321-567-2211
Mailing Address - Fax:321-286-0496
Practice Address - Street 1:600 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3489
Practice Address - Country:US
Practice Address - Phone:321-567-2211
Practice Address - Fax:321-286-0496
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant