Provider Demographics
NPI:1972501674
Name:KHORSANDIAN, ASPHENDIAR K (MD)
Entity Type:Individual
Prefix:
First Name:ASPHENDIAR
Middle Name:K
Last Name:KHORSANDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2732
Mailing Address - Country:US
Mailing Address - Phone:386-253-2518
Mailing Address - Fax:386-252-1923
Practice Address - Street 1:337 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2732
Practice Address - Country:US
Practice Address - Phone:386-253-2518
Practice Address - Fax:386-252-1923
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0048363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D84637Medicare UPIN