Healthcare Provider Details

I. General information

NPI: 1982732707
Provider Name (Legal Business Name): NASREEN RAZACK-MALIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DISCOVERY DR
ORLANDO FL
32826-3709
US

IV. Provider business mailing address

8427 DIAMOND COVE CIR
ORLANDO FL
32836-6018
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-7000
  • Fax: 407-351-8991
Mailing address:
  • Phone: 321-246-8526
  • Fax: 407-351-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 92266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: