Provider Demographics
NPI:1043007834
Name:SIDDIQUI, SADIA ASIF
Entity type:Individual
Prefix:
First Name:SADIA
Middle Name:ASIF
Last Name:SIDDIQUI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 WHALERS WAY # 4915
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2353
Mailing Address - Country:US
Mailing Address - Phone:407-427-4777
Mailing Address - Fax:
Practice Address - Street 1:4915 WHALERS WAY # 4915
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2353
Practice Address - Country:US
Practice Address - Phone:407-427-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL23000440010251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS-618-418-54-100-0OtherDRIVER'S LICENCE