Provider Demographics
NPI:1932152444
Name:NOURAFSHAR, FERESHTEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FERESHTEH
Middle Name:
Last Name:NOURAFSHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 VIA ROYALE STE 216
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1019
Mailing Address - Country:US
Mailing Address - Phone:239-277-9009
Mailing Address - Fax:
Practice Address - Street 1:4575 VIA ROYALE STE 216
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1019
Practice Address - Country:US
Practice Address - Phone:239-277-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260538400Medicaid
FLF76709Medicare UPIN