Healthcare Provider Details

I. General information

NPI: 1265828388
Provider Name (Legal Business Name): NAYER CANTON VAFABAKHSH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAITLAND AVENUE, SUITE 104
ALTAMONTE FL
32701
US

IV. Provider business mailing address

251 MAITLAND AVE, SUITE 104
ALTAMONTE FL
32701
US

V. Phone/Fax

Practice location:
  • Phone: 407-557-2165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number079936
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number057760990
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME137513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: