Provider Demographics
NPI:1518254150
Name:VAFAII, PARDIS
Entity Type:Individual
Prefix:
First Name:PARDIS
Middle Name:
Last Name:VAFAII
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MILANO CIR APT 105
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7171
Mailing Address - Country:US
Mailing Address - Phone:954-865-8886
Mailing Address - Fax:
Practice Address - Street 1:4500 SAN PABLO RD,
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0001
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 123388207ZP0105X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program