Provider Demographics
NPI:1578357976
Name:MOHAMMED, AMAL ADIL ELHASSAN
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:ADIL ELHASSAN
Last Name:MOHAMMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 CASTLEMAIN CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2894
Mailing Address - Country:US
Mailing Address - Phone:904-528-0318
Mailing Address - Fax:
Practice Address - Street 1:11081 CASTLEMAIN CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2894
Practice Address - Country:US
Practice Address - Phone:904-528-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program