Provider Demographics
NPI:1912964040
Name:SIDDIQUI, REHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:REHANA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 DUNLAWTON AV, STE 120
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8980
Mailing Address - Country:US
Mailing Address - Phone:386-271-2273
Mailing Address - Fax:386-271-2274
Practice Address - Street 1:1690 DUNLAWTON AV, STE 120
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8980
Practice Address - Country:US
Practice Address - Phone:386-271-2273
Practice Address - Fax:386-271-2274
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046702200Medicaid
FL046702200Medicaid