Provider Demographics
NPI:1194041665
Name:SIDDIQUI, YASMIN (DO)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6040
Mailing Address - Country:US
Mailing Address - Phone:954-840-0530
Mailing Address - Fax:954-840-3570
Practice Address - Street 1:1480 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6040
Practice Address - Country:US
Practice Address - Phone:954-840-0530
Practice Address - Fax:954-840-3570
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21263207QA0505X
NVDO2062207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194041665Medicaid
NV1194041665Medicaid