Provider Demographics
NPI:1306941299
Name:SALEHI, SIMIN
Entity type:Individual
Prefix:DR
First Name:SIMIN
Middle Name:
Last Name:SALEHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 TADSWORTH TER
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5333
Mailing Address - Country:US
Mailing Address - Phone:407-314-1538
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5823
Practice Address - Country:US
Practice Address - Phone:386-574-1423
Practice Address - Fax:321-684-5212
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375087601Medicaid
FL375087602Medicaid
FL375087600Medicaid
FL23667BMedicare PIN