Provider Demographics
NPI:1972930717
Name:SALIA, QAZIM (PA)
Entity type:Individual
Prefix:
First Name:QAZIM
Middle Name:
Last Name:SALIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 N WICKHAM RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8300
Mailing Address - Country:US
Mailing Address - Phone:321-567-2211
Mailing Address - Fax:321-286-0496
Practice Address - Street 1:1270 N WICKHAM RD STE 9
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8300
Practice Address - Country:US
Practice Address - Phone:321-567-2211
Practice Address - Fax:321-286-0496
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9107628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7429010OtherCIGNA
FL009918200Medicaid
FLY0KJ8OtherBCBS