Provider Demographics
NPI:1902818909
Name:TEJPAR, NAFISA A (MD PA)
Entity Type:Individual
Prefix:
First Name:NAFISA
Middle Name:A
Last Name:TEJPAR
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SHELL PT W
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5847
Mailing Address - Country:US
Mailing Address - Phone:407-644-3622
Mailing Address - Fax:407-644-1334
Practice Address - Street 1:221 SHELL PT W
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5847
Practice Address - Country:US
Practice Address - Phone:407-644-3622
Practice Address - Fax:407-644-1334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036883100Medicaid
FL036883100Medicaid
FLD64250Medicare UPIN