Provider Demographics
NPI:1659653723
Name:ASSLO, FADY (MD)
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:ASSLO
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 1:10080 SW INNOVATION WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2127
Mailing Address - Country:US
Mailing Address - Phone:772-344-3811
Mailing Address - Fax:
Practice Address - Street 1:10080 SW INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2127
Practice Address - Country:US
Practice Address - Phone:772-344-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20859207RG0100X
FLME173700207RG0100X
VT042.0017587207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology