Provider Demographics
NPI:1649271925
Name:GASHTI, SEYED-MOJTABA (DO)
Entity type:Individual
Prefix:
First Name:SEYED-MOJTABA
Middle Name:
Last Name:GASHTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21966 CANADENSIS CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3911
Mailing Address - Country:US
Mailing Address - Phone:410-409-4562
Mailing Address - Fax:
Practice Address - Street 1:1447 MEDICAL PARK BLVD STE 405
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3183
Practice Address - Country:US
Practice Address - Phone:561-767-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239940208600000X
MDH00623932086S0129X
FLOS14009208600000X
NJ25MB06746000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7978103Medicaid
FL020127500Medicaid
FL007978103Medicaid
NJ027612Medicare ID - Type Unspecified