Provider Demographics
NPI:1396529319
Name:METWALEY, MOHAMED G (PA)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:G
Last Name:METWALEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5352 NE 6TH AVE # 9E
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3444
Mailing Address - Country:US
Mailing Address - Phone:954-789-9700
Mailing Address - Fax:
Practice Address - Street 1:5352 NE 6TH AVE # 9E
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3444
Practice Address - Country:US
Practice Address - Phone:954-789-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant