Provider Demographics
NPI:1235576224
Name:GHAEDI, KAVEH (DO)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:GHAEDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 US 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7451
Mailing Address - Country:US
Mailing Address - Phone:727-541-2646
Mailing Address - Fax:727-541-4402
Practice Address - Street 1:11300 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-7451
Practice Address - Country:US
Practice Address - Phone:727-541-2646
Practice Address - Fax:727-541-4402
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS154262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry