Provider Demographics
NPI:1336529650
Name:MOHIUDDIN, YASMIN (DO)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:MOHIUDDIN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RINEHART RD STE 3050
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2576
Mailing Address - Country:US
Mailing Address - Phone:321-842-2800
Mailing Address - Fax:321-843-8777
Practice Address - Street 1:392 RINEHART RD STE 3050
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2576
Practice Address - Country:US
Practice Address - Phone:321-842-2800
Practice Address - Fax:321-843-8777
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14302207QG0300X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104128300Medicaid