Healthcare Provider Details

I. General information

NPI: 1306721717
Provider Name (Legal Business Name): PADIDEH DEHGHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9582 W COLONIAL DR
OCOEE FL
34761-6992
US

IV. Provider business mailing address

9582 W COLONIAL DR
OCOEE FL
34761-6992
US

V. Phone/Fax

Practice location:
  • Phone: 407-499-0399
  • Fax:
Mailing address:
  • Phone: 407-499-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: