Provider Demographics
NPI:1003909748
Name:GHARSRI-ZARGHAMI-SABET, SHAHLA (CNM)
Entity Type:Individual
Prefix:MS
First Name:SHAHLA
Middle Name:
Last Name:GHARSRI-ZARGHAMI-SABET
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY
Mailing Address - Street 2:D1-01
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-1920
Mailing Address - Fax:718-334-5958
Practice Address - Street 1:43-12 43RD ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2608
Practice Address - Country:US
Practice Address - Phone:718-334-6230
Practice Address - Fax:718-334-6231
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000909367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid