Individual
KHADIJAH FERGIANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TRN27510
FL
208M00000X
Hospitalist Physician
Primary
ME152700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115413300
—
FL
01
—
PS421
MEDICARE HF
FL
Enumeration date
06/29/2018
Last updated
09/17/2022
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