Provider Demographics
NPI:1790515161
Name:HADDAD, MUNA WASFI (MBBS)
Entity type:Individual
Prefix:
First Name:MUNA
Middle Name:WASFI
Last Name:HADDAD
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SW 144TH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-6393
Mailing Address - Country:US
Mailing Address - Phone:862-529-7336
Mailing Address - Fax:
Practice Address - Street 1:622 SW 144TH DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-6393
Practice Address - Country:US
Practice Address - Phone:862-529-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN41124390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program