| Ashfaq Kudia, M.d., P.a. | |
|
1301 Plantation Island Dr S Suite 302a Saint Augustine FL 32080-3108 | |
| (904) 461-9330 | |
| (904) 461-9331 |
| Full Name | Ashfaq Kudia, M.d., P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1301 Plantation Island Dr S, Saint Augustine, Florida |
| Authorized Official Name and Position | Furrin Kudia (OFFICE MANAGER) |
| Authorized Official Contact | 9044619330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ashfaq Kudia, M.d., P.a. Po Box 3208 Suite 302a Saint Augustine FL 32085-3208 Ph: (904) 461-9330 | Ashfaq Kudia, M.d., P.a. 1301 Plantation Island Dr S Suite 302a Saint Augustine FL 32080-3108 Ph: (904) 461-9330 |
| NPI Number | 1265675219 |
|---|---|
| Provider Enumeration Date | 04/07/2009 |
| Last Update Date | 07/12/2010 |
| Medicare PECOS PAC ID | 8224165410 |
|---|---|
| Medicare Enrollment ID | O20100420000535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265675219 | NPI | - | NPPES |
| 28138 | Other | FL | BC/BS |
| 379026600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME0068850 (Florida) | Primary |
| Provider Name | Ashfaq L. Kudia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669482188 PECOS PAC ID: 8426074873 Enrollment ID: I20051015000018 |
| Provider Name | Jesse Michael Fazzingo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316487218 PECOS PAC ID: 8426326893 Enrollment ID: I20170608001064 |
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