MEDICARE: FARSHAD NASTAEIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	27625	FL

General Provider Information

NPI Number	:	1891391793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARSHAD NASTAEIN

Provider Business Mailing Address
First Line	:	5125 PALM SPRINGS BLVD UNIT 11205
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-5022
Country	:	US
Telephone Number	:	832-353-5729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 W REYNOLDS ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4700
Country	:	US
Telephone Number	:	813-567-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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Directions to “ FARSHAD NASTAEIN ” Practice Location

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