Healthcare Provider Details

I. General information

NPI: 1912811043
Provider Name (Legal Business Name): SHIVA RAZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 LEE RD
WINTER PARK FL
32789-1750
US

IV. Provider business mailing address

2619 LAFAYETTE AVE
WINTER PARK FL
32789-1372
US

V. Phone/Fax

Practice location:
  • Phone: 617-669-3994
  • Fax:
Mailing address:
  • Phone: 617-669-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: