Provider Demographics
NPI:1003280918
Name:RAD, SHIRIN S
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:S
Last Name:RAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OAKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2013
Mailing Address - Country:US
Mailing Address - Phone:508-933-1878
Mailing Address - Fax:
Practice Address - Street 1:345A GREENWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607
Practice Address - Country:US
Practice Address - Phone:508-933-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist