Provider Demographics
NPI:1629456967
Name:OSTANE, KASHANOSTANE
Entity Type:Individual
Prefix:MR
First Name:KASHANOSTANE
Middle Name:
Last Name:OSTANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4602
Mailing Address - Country:US
Mailing Address - Phone:561-336-1265
Mailing Address - Fax:
Practice Address - Street 1:4890 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4602
Practice Address - Country:US
Practice Address - Phone:561-336-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163W00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator