Provider Demographics
NPI:1437507886
Name:POUSHANCHI, BEHDOD (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHDOD
Middle Name:
Last Name:POUSHANCHI
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 1:7300 SANDLAKE COMMONS BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8011
Mailing Address - Country:US
Mailing Address - Phone:321-843-4344
Mailing Address - Fax:321-842-4784
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 127
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8011
Practice Address - Country:US
Practice Address - Phone:321-843-4344
Practice Address - Fax:321-842-4784
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
FLME156323207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114533600Medicaid