| Qualicare Psychiatry L.l.c. | |
|
42725 Us-27 Suite # 202 Davenport FL 33837 | |
| (520) 907-6833 | |
| Not Available |
| Full Name | Qualicare Psychiatry L.l.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 42725 Us-27, Davenport, Florida |
| Authorized Official Name and Position | Fady Ashamalla (OWNER AND DIRECTOR) |
| Authorized Official Contact | 4078083808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Qualicare Psychiatry L.l.c. 42725 Highway 27 Suite 202 Davenport FL 33837-6821 Ph: (407) 808-3808 | Qualicare Psychiatry L.l.c. 42725 Us-27 Suite # 202 Davenport FL 33837 Ph: (520) 907-6833 |
| NPI Number | 1962958264 |
|---|---|
| Provider Enumeration Date | 08/28/2016 |
| Last Update Date | 09/19/2016 |
| Medicare PECOS PAC ID | 8729367727 |
|---|---|
| Medicare Enrollment ID | O20161115001818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962958264 | NPI | - | NPPES |
| 1912163866 | Other | NPI (SELF) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME117175 (Florida) | Primary |
| Provider Name | Fady Ashamalla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912163866 PECOS PAC ID: 9638458631 Enrollment ID: I20161115002140 |
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