Provider Demographics
NPI:1912202755
Name:RAHMAN, OMAR (PHD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:800 6TH ST S
Practice Address - Street 2:BOX 7523
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4817
Practice Address - Country:US
Practice Address - Phone:727-767-4150
Practice Address - Fax:727-767-8532
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593J4OtherBLUE CROSS BLUE SHIELD
FLEP419ZMedicare PIN