Provider Demographics
NPI:1295751329
Name:SHOKOOHI, AHMAD
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:SHOKOOHI
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 1:7480 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9102
Mailing Address - Country:US
Mailing Address - Phone:407-657-7799
Mailing Address - Fax:407-657-7928
Practice Address - Street 1:7480 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9102
Practice Address - Country:US
Practice Address - Phone:407-657-7799
Practice Address - Fax:407-657-7928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33049207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33049OtherSTATE
FS0901339OtherCHAMPUS TRICARE
FL037761900Medicaid
FL33049OtherSTATE
48996Medicare ID - Type Unspecified