Provider Demographics
NPI:1871566786
Name:ZEINI, MINA MAMDOUH (MD)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:MAMDOUH
Last Name:ZEINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GRUMMAN PLACE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-269-4240
Mailing Address - Fax:321-269-5428
Practice Address - Street 1:1250 GRUMMAN PLACE, SUITE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-269-4240
Practice Address - Fax:321-269-5428
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86118207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLK901OtherMEDICARE
FL269816100Medicaid