TARA DERAKHSHANDEH (NPI# 1609353713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609353713 |
| Entity Type | Individual |
| Full Name | TARA DERAKHSHANDEH |
| Credential | DMD |
| Practice Address |
3590 Bayside Lakes Blvd Se Palm Bay FL 32909 |
| Mailing Address |
3590 Bayside Lakes Blvd Se Palm Bay FL 32909-6866 |
| Practice Telephone | 3219840044 |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2018-08-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DN23654 | FL | Dental Providers |
| Street Address |
3590 BAYSIDE LAKES BLVD SE |
| City | PALM BAY |
| State | FL |
| Zip Code | 32909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285047506 | New Image Dentisty of Palm Bay | Dentist | 3590 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6866 | 2014-06-04 |
| 1679002604 | Lina Alejandra Ramirez | Dentist | 3590 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6866 | 2017-06-04 |
| 1881075760 | Farid Mastali | Dentist | 3590 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6866 | 2015-06-16 |
| 1063828218 | Kasim Manzur | Dentist | 3590 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6866 | 2014-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447349 | Sarah Nicosia | Registered Nurse | 2752 Palisades Dr, Palm Bay, FL 32909 | 2020-08-12 |
| 1447881297 | Shangri-la of Palm Bay Alf, LLC | Assisted Living Facility | 3604 Jupiter Blvd. Se, Palm Bay, FL 32909 | 2020-01-30 |
| 1972094357 | Mindful Counseling and Wellness LLC | Social Worker | 221 Devlin Ct Se, Palm Bay, FL 32909 | 2018-05-22 |
| 1306348859 | Mallory Kathleen Herndon | Behavior Technician | 458 Barcelona Rd, Palm Bay, FL 32909 | 2018-03-01 |
| 1548786627 | Chotsani Merrill | Home Health Aide | 781 Davenport St Se, Palm Bay, FL 32909 | 2017-08-21 |
| 1639629538 | Maggie Cameron | Clinic/Center | 2511 Quentin Ave Ne, Palm Bay, FL 32909 | 2016-10-04 |
| 1194195016 | Dawn Goodwin | Pharmacist | 3450 Bayside Lakes Shopping Center, Palm Bay, FL 32909 | 2015-10-05 |
| 1124407796 | Jorge Ortiz | Physical Therapist | 470 Malabar Rd Se, Ste 102, Palm Bay, FL 32909 | 2015-05-28 |
| 1932506227 | Annalisa Tietjen I | Dental Hygienist | 714 Ave C, Fort Pierce, FL 32909 | 2014-12-02 |
| 1194147611 | Carl Glenmore Morrison Sr. | General Practice | 2125 Windbrook Drive, Palm Bay, FL 32909 | 2014-01-17 |
| Find all providers in zip 32909 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700436615 | Gladysbel Jimenez | Dentist | 5132 Minton Rd Nw, Palm Bay, FL 32907-1110 | 2019-09-13 |
| 1952875635 | Luis Carlos Mejia | Dentist | 620 Malabar Rd Se Ste 3, Palm Bay, FL 32907-3109 | 2019-01-16 |
| 1063826170 | New Image Dentistry On Minton | Dentist | 5132 Minton Rd Nw Ste 1, Palm Bay, FL 32907-1110 | 2014-06-17 |
| 1265704548 | Atm Amin Dds LLC | Dentist | 4620 Lipscomb St Ne, Suite 2, Palm Bay, FL 32905 | 2012-02-02 |
| 1174803340 | Ronald Gene List | Dentist | 1460 Baytree Dr Ne, Palm Bay, FL 32905-3900 | 2011-08-19 |
| 1134427859 | Mark Joseph Urban | Dentist | 2061 Palm Bay Rd Ne, Suite #103, Palm Bay, FL 32905-7533 | 2011-03-03 |
| 1306155163 | Robert Willard Underill Jr. | Dentist | 2156 Julian Ave Ne, Palm Bay, FL 32905-4020 | 2010-09-28 |
| 1669780284 | Capeside Dental | Dentist | 3265 Bayside Lakes Blvd Se, Palm Bay, FL 32909-6872 | 2010-09-16 |
| 1326233214 | Andrea Elaine Cunningham | Dentist | 620 Malabar Rd Se, Suite 3, Palm Bay, FL 32907 | 2007-09-13 |
| 1831396282 | Jefferson Michael Pecora | Dentist | 2105 Palm Bay Road Ne Ste 4-5, Palm Bay, FL 32905 | 2007-06-29 |
| Find all providers in PALM BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.