ABDUL KHALIL WALLIZADAMD NPI 1053360669

NPI Information

  • NPI: 1053360669
  • Provider Name: ABDUL KHALIL WALLIZADA,MD
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Organization
  • Doing Business As: PEDIATRICS AND ADOLESCENT MEDICINE
  • CLIA Number: 10D0931750
  • Address: 2140 KINGSLEY AVE
    STE.#10
    ORANGE PARK, FL
    ZIP 32073
  • Phone: (904) 276-0005

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NPI Details

ABDUL KHALIL WALLIZADA,MD is an adolescent medicine pediatrics in Orange Park, FL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. ABDUL KHALIL WALLIZADA,MD NPI is 1053360669. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pediatrics And Adolescent Medicine.

The provider's business location address is:

2140 KINGSLEY AVE
STE.#10
ORANGE PARK, FL
ZIP 32073-180
Phone: (904) 276-0005
Fax: (904) 276-9202

The provider's authorized official is Abdul Khalil Wallizada .
The authorized official title is Owner and has the following contact phone number (904) 276-0005.

The CLIA number assigned to this NPI record is 10D0931750 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2006 and was last updated on 7/7/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent MedicineME0067026FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1F90013MEDICARE UPINFLORIDA
225991MEDICARE ID-TYPE UNSPECIFIEDFLORIDA
3376381100MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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