Healthcare Provider Details

I. General information

NPI: 1336529650
Provider Name (Legal Business Name): YASMIN MOHIUDDIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 RINEHART RD STE 3050
LAKE MARY FL
32746-2576
US

IV. Provider business mailing address

392 RINEHART RD STE 3050
LAKE MARY FL
32746-2576
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-2800
  • Fax: 321-843-8777
Mailing address:
  • Phone: 321-842-2800
  • Fax: 321-843-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14302
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS14302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: