Provider Demographics
NPI:1205125069
Name:NICHI ENTERPRISES INC
Entity type:Organization
Organization Name:NICHI ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:HADI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-347-8339
Mailing Address - Street 1:1151 BLACKWOOD AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4550
Mailing Address - Country:US
Mailing Address - Phone:407-347-8339
Mailing Address - Fax:407-347-8394
Practice Address - Street 1:1151 BLACKWOOD AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4550
Practice Address - Country:US
Practice Address - Phone:407-347-8339
Practice Address - Fax:407-347-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108175207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003696100Medicaid
FLFD798AMedicare PIN