Provider Demographics
NPI:1295259364
Name:ELSEEDAH, AZHARY OMAR (OWNER)
Entity type:Individual
Prefix:
First Name:AZHARY
Middle Name:OMAR
Last Name:ELSEEDAH
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 JARL CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4875
Mailing Address - Country:US
Mailing Address - Phone:1303-263-0514
Mailing Address - Fax:832-553-7818
Practice Address - Street 1:4914 JARL CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4875
Practice Address - Country:US
Practice Address - Phone:1303-263-0514
Practice Address - Fax:832-553-7818
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)