Provider Demographics
NPI:1043605397
Name:MIRI, SHAHNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAZ
Middle Name:
Last Name:MIRI
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 1:2186 GEARY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3456
Mailing Address - Country:US
Mailing Address - Phone:415-800-4178
Mailing Address - Fax:415-800-4942
Practice Address - Street 1:2186 GEARY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3456
Practice Address - Country:US
Practice Address - Phone:415-800-4178
Practice Address - Fax:415-800-4942
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1817002084N0400X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Multi-Specialty