Provider Demographics
NPI:1083693279
Name:HUSAINY, TAHER (MD)
Entity type:Individual
Prefix:DR
First Name:TAHER
Middle Name:
Last Name:HUSAINY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:1395 N COURTENAY PKWY STE 106
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4474
Practice Address - Country:US
Practice Address - Phone:321-452-1224
Practice Address - Fax:321-453-7784
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041139204D00000X
FLME411392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL130023529OtherRAILROAD MEDICARE
FL31144OtherBLUE CROSS
FL592458061001OtherCHAMPUS
FL127527900Medicaid
FL4311627OtherAETNA
FLME41139OtherMEDICAL LICENSE
FLME0041139OtherFLORIDA WORK COMP
FL069782600Medicaid