Provider Demographics
NPI:1184000168
Name:FARD, SHABNAM (APRN)
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:FARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 CRANES ROOST BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3437
Mailing Address - Country:US
Mailing Address - Phone:407-990-1010
Mailing Address - Fax:407-536-5699
Practice Address - Street 1:283 CRANES ROOST BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3437
Practice Address - Country:US
Practice Address - Phone:407-990-1010
Practice Address - Fax:407-536-5699
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9332371363LA2200X, 363LG0600X, 363LP2300X
FL9332371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care