Provider Demographics
NPI:1952961427
Name:HADJIMIRY, FARAHNAZ REBECCA
Entity Type:Individual
Prefix:
First Name:FARAHNAZ
Middle Name:REBECCA
Last Name:HADJIMIRY
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 1:2923 S FEDERAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7745
Mailing Address - Country:US
Mailing Address - Phone:561-752-0100
Mailing Address - Fax:561-740-3001
Practice Address - Street 1:2923 S FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7745
Practice Address - Country:US
Practice Address - Phone:561-752-0100
Practice Address - Fax:561-740-3001
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112433363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical