Provider Demographics
NPI:1295398006
Name:YAZDANI, NEDA
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:YAZDANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 LAKEBREEZE LN S
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1042
Mailing Address - Country:US
Mailing Address - Phone:727-365-9125
Mailing Address - Fax:
Practice Address - Street 1:2655 LAKEBREEZE LN S
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1042
Practice Address - Country:US
Practice Address - Phone:727-365-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-329246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant