Provider Demographics
NPI:1144108903
Name:WOOD, JASMIN JAHANDAR
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:JAHANDAR
Last Name:WOOD
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 1:2220 SAMPER LN APT 7
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-7751
Mailing Address - Country:US
Mailing Address - Phone:424-354-7507
Mailing Address - Fax:
Practice Address - Street 1:2220 SAMPER LN APT 7
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-7751
Practice Address - Country:US
Practice Address - Phone:424-354-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant