Provider Demographics
NPI:1023632650
Name:TANVEER, REZA ZAYN
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:ZAYN
Last Name:TANVEER
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 1:1285 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4984
Mailing Address - Country:US
Mailing Address - Phone:407-647-2287
Mailing Address - Fax:
Practice Address - Street 1:1285 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4984
Practice Address - Country:US
Practice Address - Phone:407-647-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125076425208100000X
FLOS21099208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123210700Medicaid