Basic Information
| Provider Information | |||||||||
| NPI: | 1114422342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROOHANI | ||||||||
| FirstName: | CHEYENNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 DAVIS BLVD STE 308 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132502506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 DAVIS BLVD STE 308 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132502506 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 10/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | TRN27413 | FL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 27413 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.