Provider Demographics
NPI:1881385862
Name:NIZAMUDDIN, NASHEEN
Entity type:Individual
Prefix:
First Name:NASHEEN
Middle Name:
Last Name:NIZAMUDDIN
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 1:13266 PINE GAP SPUR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2544
Mailing Address - Country:US
Mailing Address - Phone:734-444-8390
Mailing Address - Fax:
Practice Address - Street 1:13266 PINE GAP SPUR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2544
Practice Address - Country:US
Practice Address - Phone:734-444-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL29469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program