Healthcare Provider Details

I. General information

NPI: 1295312403
Provider Name (Legal Business Name): AHRASH KHAJAEI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19735 US HIGHWAY 441 FL 2
MOUNT DORA FL
32757-2204
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3251
  • Fax: 352-755-9838
Mailing address:
  • Phone:
  • Fax: 352-755-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS19969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: