Provider Demographics
NPI:1316991516
Name:MADHANY, NASIRDIN (MD)
Entity type:Individual
Prefix:DR
First Name:NASIRDIN
Middle Name:
Last Name:MADHANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7854
Mailing Address - Country:US
Mailing Address - Phone:407-331-1121
Mailing Address - Fax:407-331-1156
Practice Address - Street 1:631 PALM SPRINGS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-331-1121
Practice Address - Fax:407-331-1156
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62026OtherBCBS
AM8687177OtherDEA
D86145Medicare UPIN
FL62026WMedicare PIN