Healthcare Provider Details

I. General information

NPI: 1891001400
Provider Name (Legal Business Name): SHAHRAM MORI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 601
ORLANDO FL
32804-5558
US

IV. Provider business mailing address

3150 N TENAYA WAY STE 520
LAS VEGAS NV
89128-0448
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2070
  • Fax: 407-303-2071
Mailing address:
  • Phone: 702-962-2100
  • Fax: 702-962-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR72223
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME120835
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberR72223
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA124379
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME120835
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number21041
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: