Provider Demographics
NPI:1912215179
Name:ROOHI, MAHSHID N/A (NP)
Entity Type:Individual
Prefix:MRS
First Name:MAHSHID
Middle Name:N/A
Last Name:ROOHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:3300 W LAKE MARY BLVD STE 100
Practice Address - Street 2:NEMOURS CHILDRENS SPECIALTY CARE, LAKE MARY
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3499
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9391935363L00000X, 363LP0200X
NMCNP-O1664363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013328100Medicaid