Active NPI
Khashayar Alex Daneshmand, DO
- Pediatric Critical Care Medicine Physician
- Ft Myers, FL
National Provider Identifier
1720005515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- OS9802
- Practice address
- 9981 Healthpark Drive
Ft Myers, FL 33908 - Phone
- (239) 343-5651
- Fax
- (239) 343-5652
- NPI assigned
- Jul 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | OS9802 | FL | Primary |
Addresses
Primary practice location
9981 Healthpark Drive
Ft Myers, FL 33908
Mailing address
PO Box 2147
Ft Myers, FL 33902-2147
Phone (239) 343-6001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 275563700 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS9802 | FL | MD | Pediatric Critical Care Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597795200000",
"number": "1720005515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2147",
"city": "FT MYERS",
"state": "FL",
"postal_code": "339022147",
"telephone_number": "239-343-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9981 HEALTHPARK DRIVE",
"city": "FT MYERS",
"state": "FL",
"postal_code": "33908",
"telephone_number": "239-343-5651",
"fax_number": "239-343-5652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANESHMAND",
"first_name": "KHASHAYAR",
"middle_name": "ALEX",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-16",
"last_updated": "2020-08-19",
"certification_date": "2020-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "FL",
"license": "OS9802",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "275563700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ft Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.