Qualicare Psychiatry L.L.C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME117175 Issued in FL

Legal business name

QUALICARE PSYCHIATRY L.L.C.

Practice address

42725 US-27
Suite # 202
Davenport, FL 33837

Phone

(520) 907-6833

NPI assigned

Aug 28, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fady Ashamalla, M.D.NPI 1912163866

Title

Owner and Director

Phone

(407) 808-3808

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fady Ashamalla

  • Psychiatry Physician
  • Davenport, FL
  • NPI 1912163866
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1962958264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42725 HIGHWAY 27",
            "address_2": "SUITE 202",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338376821",
            "telephone_number": "407-808-3808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42725 US-27",
            "address_2": "SUITE # 202",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "33837",
            "telephone_number": "520-907-6833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALICARE PSYCHIATRY L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "ASHAMALLA",
        "authorized_official_first_name": "FADY",
        "authorized_official_title_or_position": "OWNER AND DIRECTOR",
        "authorized_official_telephone_number": "407-808-3808",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME117175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI (SELF)",
            "identifier": "1912163866",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Davenport, FL
• Providers in Davenport, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.