=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811176910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELDAR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2007
-----------------------------------------------------
Last Update Date | 10/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 MANATEE AVE EAST
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-747-8272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 MANATEE AVE EAST
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-747-8272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AHMAD SAHEBZAMANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-747-8272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------