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PEDIATRICS AND ADOLESCENT MEDICINE
NPI 1053360669
Pediatrics - Adolescent Medicine in Orange Park, FL

Active since May 09, 2006CLIA 10D0931750 · Waiver
2140 KINGSLEY AVE, STE.#10, ORANGE PARK, FL 32073(904) 276-0005(904) 276-9202 Get Directions Write a Review

NPPES record last updated: July 7, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pediatrics And Adolescent Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRICS AND ADOLESCENT MEDICINE (NPI 1053360669) is a healthcare organization registered as an adolescent medicine in Orange Park, Florida and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through August 4, 2027 and lists Abdul Khalil Wallizada, Owner, as its authorized official.

NPPES Registry Identity

NPI1053360669
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameABDUL KHALIL WALLIZADA,MD
Location Address2140 KINGSLEY AVE, STE.#10Orange Park, FL 32073-5180
Mailing Address2140 Kingsley Ave, Ste.#10Orange Park, FL 32073-5180 · (904) 276-0005 · Fax (904) 276-9202
Phone(904) 276-0005
Fax(904) 276-9202
Organization SubpartNo
Authorized OfficialAbdul Khalil WallizadaOwner · (904) 276-0005
Enumeration DateMay 9, 2006
Last NPPES UpdateJuly 7, 2008
✔ NPI 1053360669 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in FL · ME0067026
Definition
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.
2140 KINGSLEY AVE, Orange Park, FL 32073
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Other Names 1

Doing Business AsPediatrics And Adolescent Medicine

Other Identifiers 3

Medicare UPINF90013FL
Medicare ID-Type Unspecified25991FL
Medicaid376381100FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0931750

Pediatrics And Adolescent Medicine · Orange Park, FL
Active · expires Aug 4, 2027
CLIA Number10D0931750
Laboratory TypePhysician Office
Certificate Effective DateAugust 5, 2025
Certificate Expiration DateAugust 4, 2027
Laboratory DirectorKhalil A. Wallizada
Laboratory Phone(904) 276-0005
Laboratory LocationPediatrics And Adolescent Medicine2051 Professional Center Dr, Orange Park, FL 32073
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALEXANDRA RICHETTI
Counselor (Mental Health)
2140 KINGSLEY AVE
ORANGE PARK, FL 32073
Clay County (904) 375-8388
DR. NADEEM MAALOULI M.D.
Internal Medicine
2140 KINGSLEY AVE
ORANGE PARK, FL 32073
Clay County (904) 213-0600
PODIATRY ASSOCIATES OF FLORIDA INC
Podiatrist (Foot & Ankle Surgery)
2140 KINGSLEY AVE, STE 12
ORANGE PARK, FL 32073
Clay County (904) 272-7070
MR. DANNY WAYNE WELDON P.T.
Physical Therapist
2140 KINGSLEY AVE
ORANGE PARK, FL 32073
Clay County (904) 272-2830
SALLY MACDONALD ARMISTEAD FNP
Nurse Practitioner (Family)
2140 KINGSLEY AVE
ORANGE PARK, FL 32073
Clay County (904) 213-0600
SOLANTIC OF JACKSONVILLE, LLC
Clinic/Center (Urgent Care)
2140 KINGSLEY AVE
ORANGE PARK, FL 32073
Clay County (904) 213-0600
MRS. ELLEN LOUISE POTTS ARNP
Nurse Practitioner
2140 KINGSLEY AVE, SUITE 2
ORANGE PARK, FL 32073
Clay County (904) 886-4878
BARRY L EFRON DPM
Podiatrist (Foot & Ankle Surgery)
2140 KINGSLEY AVE, STE 12
ORANGE PARK, FL 32073
Clay County (904) 272-7070

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Abdul Khalil Wallizada,md's NPI number?

The NPI number for Abdul Khalil Wallizada,md is 1053360669. It was assigned to this organization in the NPPES registry on May 9, 2006. The provider is doing business as Pediatrics And Adolescent Medicine.

Where is Abdul Khalil Wallizada,md located?

Abdul Khalil Wallizada,md is located at 2140 Kingsley Ave Ste.#10, Orange Park, FL 32073. The listed phone number is (904) 276-0005.

What is Abdul Khalil Wallizada,md's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Abdul Khalil Wallizada,md hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0931750) is associated with this NPI, valid through August 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Abdul Khalil Wallizada,md was last updated on July 7, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.