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2971 Park Pond Way Kissimmee FL 34741-7661 | |
| (407) 775-2121 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2971 Park Pond Way, Kissimmee, Florida |
| Authorized Official Name and Position | Iffat Zaheer (OWNER) |
| Authorized Official Contact | 4077752121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1834 Derby Glen Dr Orlando FL 32837-8102 Ph: (321) 287-6866 | 2971 Park Pond Way Kissimmee FL 34741-7661 Ph: (407) 775-2121 |
| NPI Number | 1104458769 |
|---|---|
| Provider Enumeration Date | 02/11/2020 |
| Last Update Date | 01/09/2025 |
| Medicare PECOS PAC ID | 8123448313 |
|---|---|
| Medicare Enrollment ID | O20201008001486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104458769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Richardo Ramon Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497095798 PECOS PAC ID: 1759516867 Enrollment ID: I20131025001665 |
| Provider Name | Jana Erika Cua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225491087 PECOS PAC ID: 6608160635 Enrollment ID: I20200615001481 |
| Provider Name | Henry Chavez Cuffaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912348061 PECOS PAC ID: 7517236268 Enrollment ID: I20240305001276 |
| Provider Name | Michael Oliva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578988085 PECOS PAC ID: 4486090818 Enrollment ID: I20240307003795 |
| Provider Name | Codie Vassar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538690995 PECOS PAC ID: 5496009565 Enrollment ID: I20240308003215 |
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