Healthcare Provider Details

I. General information

NPI: 1295398006
Provider Name (Legal Business Name): NEDA YAZDANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 LAKEBREEZE LN S
CLEARWATER FL
33759-1042
US

IV. Provider business mailing address

2655 LAKEBREEZE LN S
CLEARWATER FL
33759-1042
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-9125
  • Fax:
Mailing address:
  • Phone: 727-365-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number15-329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: