Hamidreza Ebneshahidi, MD
Individual provider Active NPI General Practice Physician · Debary, FL
NPI 1710473889 · NPPES record last updated Nov 21, 2025
Key facts
- NPI
- 1710473889
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- ACN1122 (FL)
- Practice address
- 110 Pond CT Ste 301
Debary, FL 32713-2717 - Phone
- (386) 259-4258
- Fax
- (877) 569-2113
- NPI assigned
- Jul 2, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Premier Physician Associates, P.a.
Practice addresses (Care Compare)
110 Pond CT
Suite 301
Debary, FL 32713-2717
Phone (818) 575-0204
Hospital & facility affiliations
- Vitas Healthcare Corporation of Florida
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PR, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181214002889 | PR | Practitioner - General Practice | 4688919954 | Practice locations: Vega Baja, PR |
| I20190329002192 | FL | Practitioner - General Practice | 4688919954 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACN1122 | FL | MD | General Practice Physician |
Practice roles (4 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Physician Associates, P.a. | Multi-Specialty | Current |
Accepting new patients |
| Florida Medical Associates LLC | Multi-Specialty | Current |
Accepting new patients |
| Orlando Family Physicians, LLC | Multi-Specialty | Current |
Accepting new patients |
| Idelis Fedeslinda Arias de la Torre | Multi-Specialty | Past |
Accepting new patients |
Locations
110 Pond Ct
Ste 301
Debary, FL 32713
Phone (386) 259-4258
13940 N US Highway 441
Ste 102
Lady Lake, FL 32159
Phone (352) 509-9900
601 E Dixie Ave
Ste 102
Leesburg, FL 34748
Phone (352) 350-8888
1130 S Semoran Blvd
Orlando, FL 32807
Phone (407) 382-1376
121 S Orange Ave
Ste 940
Orlando, FL 32801
Phone 4076589687 ext. 129
601 S Harbour Island Blvd
Ste 200
Tampa, FL 33602
Phone (727) 322-3439
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | ACN1122 | FL | Yes |
| General Practice Physician | 208D00000X | 19992 | PR |
Addresses
Primary practice location
110 Pond CT Ste 301
Debary, FL 32713-2717
Mailing address
110 Pond CT Ste 301
Debary, FL 32713-2717
Phone (386) 259-4258
Other providers in Debary, FL
- Donna Stapleton
- Richard Allan Dowling
- Deandrea Yvonne Duffus
- Baylee Eads
- Alireza Ebneshahidi
- Edwards Family Health PA
- Casey El Sesy
- Elevation Health Debary, LLC
- Endodontics
- Monica Escobar
All providers in Debary, FL · General Practice Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.