Provider Demographics
NPI:1164632550
Name:NASSERZARE, JAHANBAKHSH (MD)
Entity Type:Individual
Prefix:
First Name:JAHANBAKHSH
Middle Name:
Last Name:NASSERZARE
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 1:1380 NE MIAMI GARDENS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4744
Mailing Address - Country:US
Mailing Address - Phone:305-940-0064
Mailing Address - Fax:305-940-0066
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 140
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4744
Practice Address - Country:US
Practice Address - Phone:305-940-0064
Practice Address - Fax:305-940-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1026042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002467900Medicaid
FL010587700Medicaid
FL010587700Medicaid
FL002467900Medicaid