Healthcare Provider Details

I. General information

NPI: 1316411366
Provider Name (Legal Business Name): SHAHENAZ JIVANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W BAY AVE
LONGWOOD FL
32750-4125
US

IV. Provider business mailing address

231 W BAY AVE
LONGWOOD FL
32750-4125
US

V. Phone/Fax

Practice location:
  • Phone: 407-731-0252
  • Fax:
Mailing address:
  • Phone: 407-731-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN11000671
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP11000671
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11000671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: