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General NPI Number Information
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NPI Number | 1306872767
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA BREAST CENTER, PA
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 2200 GLENWOOD DR SUITE 201
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City | WINTER PARK
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State | FL
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Zip | 32792-3315
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Country | US
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Telephone | 407-740-5127
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Fax | 407-740-0827
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Provider Business Mailing Address
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Address Line | 2200 GLENWOOD DR SUITE 201
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City | WINTER PARK
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State | FL
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Zip | 32792-3315
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Country | US
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Telephone | 407-740-5127
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Fax | 407-740-0827
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AZIZ SHAHBUDDIN JASANI
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Credential | M.B.A.
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Telephone | 407-740-5127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS0006978
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License Number State | FL
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