Provider Demographics
NPI:1932169398
Name:QAIYUMI, SHAHEDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHEDA
Middle Name:
Last Name:QAIYUMI
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 1:1020 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4113
Mailing Address - Country:US
Mailing Address - Phone:407-870-1579
Mailing Address - Fax:407-870-2353
Practice Address - Street 1:1020 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4113
Practice Address - Country:US
Practice Address - Phone:407-870-1579
Practice Address - Fax:407-870-2353
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0042491207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01363OtherBCBS
FL01363OtherBCBS
FL01363Medicare PIN
FL01363OtherBCBS