Organization
QUALICARE PSYCHIATRY L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADY ASHAMALLA M.D. (OWNER AND DIRECTOR)
(407) 808-3808
Entity
Organization
Contact information
Practice address
42725 US-27, SUITE # 202, DAVENPORT, FL 33837
(520) 907-6833
Mailing address
42725 HIGHWAY 27, SUITE 202, DAVENPORT, FL 33837-6821
(407) 808-3808
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME117175
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912163866
NPI (SELF)
—
Enumeration date
08/28/2016
Last updated
09/19/2016
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