Provider Demographics
NPI:1639987423
Name:KERMALLI, MAHEK FATEMA (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:MAHEK
Middle Name:FATEMA
Last Name:KERMALLI
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:MAHEK
Other - Middle Name:FATEMA
Other - Last Name:SHAIKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 N MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:635 N MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4422
Practice Address - Country:US
Practice Address - Phone:407-436-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9119654363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical