Individual ProviderPegah Yaghoubi YeganehNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address12280 Lake Underhill Rd, Orlando, FL 32825-5009(866) 389-2727(321) 230-0971PECOS EnrollmentBased on the most recent information from CMS, provider Pegah Yaghoubi Yeganeh is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1518444397Provider TypeIndividualFull NameYaghoubi Yeganeh, PegahGenderFemaleSole ProprietorNoEnumeration Date7/24/2018Last Updated7/9/2024Contact InformationPractice LocationPractice Address12280 Lake Underhill Rd, Orlando, FL 32825-5009Phone(866) 389-2727FaxUnlisted FaxMailing LocationMailing Address313 Bougival Ct, Orlando, FL 32828-8223Phone(321) 230-0971FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP9333392FloridaCode163WI0500XDescriptionRegistered NurseNursing Service ProvidersLicenseRN9333392Florida