Healthcare Provider Details

I. General information

NPI: 1215958756
Provider Name (Legal Business Name): AIMEE POONEH VAFAIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAR WALT DR
FORT WALTON BEACH FL
32547-6708
US

IV. Provider business mailing address

1317 EDGEWATER DR UNIT 495
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 214-676-1531
  • Fax:
Mailing address:
  • Phone: 214-676-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL9529
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME129495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: