Healthcare Provider Details

I. General information

NPI: 1952782559
Provider Name (Legal Business Name): SAFARI PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 N WYMORE RD SUITE B
WINTER PARK FL
32789-2823
US

IV. Provider business mailing address

PO BOX 490
WINTER PARK FL
32790-0490
US

V. Phone/Fax

Practice location:
  • Phone: 407-613-2473
  • Fax: 407-613-2474
Mailing address:
  • Phone: 407-613-2473
  • Fax: 407-613-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME110851
License Number StateFL

VIII. Authorized Official

Name: DR. FATAN JAAFAR
Title or Position: PRESIDENT
Credential: MD
Phone: 734-476-8989