Provider Demographics
NPI:1932156957
Name:AGHA, KANEEZ Z (MD)
Entity Type:Individual
Prefix:
First Name:KANEEZ
Middle Name:Z
Last Name:AGHA
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 1:199 S WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1131
Mailing Address - Country:US
Mailing Address - Phone:321-953-5364
Mailing Address - Fax:321-953-9975
Practice Address - Street 1:199 S WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1131
Practice Address - Country:US
Practice Address - Phone:321-953-5364
Practice Address - Fax:321-953-9975
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME070871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG34620Medicare UPIN