Healthcare Provider Details

I. General information

NPI: 1407111537
Provider Name (Legal Business Name): YASMIN KHALDON MAHMOUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQUARE DR STE 109
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

38135 MARKET SQUARE DR STE 109
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-2155
  • Fax:
Mailing address:
  • Phone: 813-780-2155
  • Fax: 813-355-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301100758
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: