Healthcare Provider Details

I. General information

NPI: 1083179311
Provider Name (Legal Business Name): FLORIDA ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 21ST AVE W
BRADENTON FL
34209-5641
US

IV. Provider business mailing address

7441 US HIGHWAY 27 N
SEBRING FL
33870-1030
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-0385
  • Fax:
Mailing address:
  • Phone: 863-382-0385
  • Fax: 834-402-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BAHRAM AHMADI
Title or Position: PRESIDENT
Credential: MD
Phone: 863-382-0385