Individual
JASMIN DIANA SHAHRESTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
17 DAVIS BLVD STE 308, TAMPA, FL 33606-3438
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-0483
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS21155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122963300
—
FL
01
—
ZKF8G
BCBS
FL
Enumeration date
04/28/2021
Last updated
11/04/2024
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