Provider Demographics
NPI:1265749956
Name:NABIZADA, VERONICA (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:NABIZADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BUBB-VOLOSHINOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-952-4220
Mailing Address - Fax:941-952-4222
Practice Address - Street 1:997 US HIGHWAY 41 BYP N
Practice Address - Street 2:SUITE 201
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6046
Practice Address - Country:US
Practice Address - Phone:941-952-4220
Practice Address - Fax:941-952-4222
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266890207Q00000X, 208M00000X
FLME116243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33181OtherBCBS OF FL
FL009025200Medicaid
FLHF422YMedicare PIN