Provider Demographics
NPI:1811255193
Name:MALI, YASMIN POUSTCHI (MD)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:POUSTCHI
Last Name:MALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:
Other - Last Name:POUSTCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5192
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-5192
Mailing Address - Country:US
Mailing Address - Phone:848-219-0247
Mailing Address - Fax:
Practice Address - Street 1:15901 BASS RD STE 108
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3838
Practice Address - Country:US
Practice Address - Phone:239-343-6050
Practice Address - Fax:239-343-6051
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00301207W00000X
FLME132900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021826500Medicaid