Provider Demographics
NPI:1265596928
Name:AYADI, MOHAMED NAZIH (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:NAZIH
Last Name:AYADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26540 ACE AVE
Mailing Address - Street 2:SUIRE 109-A
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8279
Mailing Address - Country:US
Mailing Address - Phone:352-504-0294
Mailing Address - Fax:352-323-8698
Practice Address - Street 1:26540 ACE AVE
Practice Address - Street 2:SUIRE 109-A
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8279
Practice Address - Country:US
Practice Address - Phone:352-504-0294
Practice Address - Fax:352-323-8698
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist