Provider Demographics
NPI:1124069505
Name:KHUDDUS, NAUSHEEN (MD)
Entity type:Individual
Prefix:DR
First Name:NAUSHEEN
Middle Name:
Last Name:KHUDDUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAUSHEEN
Other - Middle Name:
Other - Last Name:KHUDDUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-0489
Mailing Address - Country:US
Mailing Address - Phone:386-755-2785
Mailing Address - Fax:386-755-1128
Practice Address - Street 1:7120 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3142
Practice Address - Country:US
Practice Address - Phone:352-261-0089
Practice Address - Fax:386-755-1128
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81665207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262541500Medicaid
FL02634XMedicare PIN
FL262541500Medicaid
FLO2634ZMedicare PIN
FL262541500Medicaid