Provider Demographics
NPI:1083118285
Name:ALDYAB, MAHMOUD (MD)
Entity type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:
Last Name:ALDYAB
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 GRAND NATIONAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-422-9831
Mailing Address - Fax:407-206-1767
Practice Address - Street 1:7035 GRAND NATIONAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-422-9831
Practice Address - Fax:407-206-1767
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167520207ZP0102X
63983390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology