Provider Demographics
NPI:1528350303
Name:HASSANZADEH, BAHAREH (MD)
Entity type:Individual
Prefix:
First Name:BAHAREH
Middle Name:
Last Name:HASSANZADEH
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 1:392 RINEHART RD STE 3040
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2548
Mailing Address - Country:US
Mailing Address - Phone:321-842-2363
Mailing Address - Fax:321-842-2370
Practice Address - Street 1:392 RINEHART RD STE 3040
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2548
Practice Address - Country:US
Practice Address - Phone:321-842-2363
Practice Address - Fax:321-842-2370
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119367207W00000X, 2084N0400X
IL036.1388492084N0400X
CAC1597062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology