Healthcare Provider Details

I. General information

NPI: 1790275931
Provider Name (Legal Business Name): POONEH ALAEI TALEGHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 WELLNESS WAY STE 130
ORLANDO FL
32832-7176
US

IV. Provider business mailing address

10016 WELLNESS WAY STE 130
ORLANDO FL
32832-7176
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-0248
  • Fax: 407-671-4155
Mailing address:
  • Phone: 407-650-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4138
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: