Provider Demographics
NPI:1437876091
Name:JAZAYERI, FIROUZEH (RD)
Entity Type:Individual
Prefix:
First Name:FIROUZEH
Middle Name:
Last Name:JAZAYERI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NW 136TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4753
Mailing Address - Country:US
Mailing Address - Phone:647-893-3618
Mailing Address - Fax:352-265-6891
Practice Address - Street 1:2409 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1305
Practice Address - Country:US
Practice Address - Phone:352-265-6890
Practice Address - Fax:352-265-6891
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11488Medicaid